Transcript File

Distress Assessment & Management
Presented by: Barb Henry, APRN-BC, MSN
[email protected]
Melvin S. Gale MD & Associates
2135 Dana Ave, Suite 410
Cincinnati, Ohio 45207-1327
(513) 241-1811
http://www.galemd.com
Next CTC-ONS Meeting
Thursday, November 15th
Good Samaritan Hospital
Conference Center at 6 p.m.
Topic: Stigma, Anxiety, Depression,
And Lung Cancer
Presented by: Lisa Maggio, RN,
PhDc, MSN, OCN, CTTS
www.cincinnati.vc.ons.org
Objective
• Identify five components of distress assessment
and four interventions for distress management
using the 2012 NCCN Guidelines.
Distress Thermometer & Problem List:
Practical problems
Family problems
Emotional problems
Physical problems
Spiritual / religious concerns
NCCN, 2012
Use Distress thermometer as you would the pain scale0= no emotional distress, 10=severe emotional distress:
severe depression/suicidal thoughts/no support
Anyone who scores 4 or above on the Distress
thermometer should be referred for psychiatric
assessment, counseling and/or medications
Levine, 2012
Therapeutic Fly Fishing Retreats for Breast Cancer Survivors:
Emotional Distress Outcomes
https://www.facebook.com/#!/CastingForRecoveryOhio?fref=ts
www.castingforrecovery.org
N=44 participants from 5 states
Henry & CFR, 2012
Ages of Participants
Henry & CFR, 2012
Years Since Diagnosis
Henry & CFR, 2012
Distress Thermometer Score
Prior to the Retreat
Henry & CFR, 2012
Distress Thermometer Score
Two Weeks Post-Retreat
Henry & CFR, 2012
Fly Fishing Retreats for Breast Cancer Survivors:
Emotional Distress & Quality Of Life Outcomes
Barbara J. Henry, MSN, APRN-BC
DNP Student, Northern Kentucky University, Highland Heights, KY
Melvin Gale, MD, & Associates
Introduction
Over 200,000 women are diagnosed each year with breast cancer (American Cancer Society, (ACS), 2012). Currently there are 2.5 million breast cancer survivors (ACS, 2012). Support groups lead to better outcomes in quality
of life-physical, emotional and social well-being. 70% of women who participate in Casting For Recovery (CFR) programs do not attend other support groups (CFR, n.d.). CFR meets an important need. Many support groups are
segregated by cancer “stage”. CFR includes Stage I through IV breast cancer survivors; in CFR-“any age, any stage” is the motto. CFR was founded by a fly fisher and a breast reconstructive surgeon in 1996 based on these
principles: • The natural world is a healing force. • Cancer survivors can benefit from one weekend free of the stresses of medical treatment, workplace, & family concerns. • Participants experience the healing power of nature in an
intimate, safe and nurturing structure. • Participants learn a fun new sport that promotes increased physical activity. CFR is a 501(c)3 non-profit organization that is endorsed by medical and psychosocial experts for its innovative
healing program model.
Findings
Methodology
This was a pre- and post-test research design with 42 women from 5 states.
The study was approved by the University of Cincinnati Internal Review Board
and determined to not cause any risk or harm to participants.
Letters of introduction to the study and distress tools with postage paid return
envelopes were mailed to participants 2 weeks prior to the retreat.
70 tools were mailed with 47 returned by mail, 42 of the 47 completed pre-retreat
tools and signed letters of consent returned, a 67% return rate.
Completed tools were assigned numbers and sent to the principal investigator
without any identifiers in order to assure confidentiality of participants.
The principal investigator is a psychosocial facilitator for CFR but did not
participate in any retreats held in 2011 when the data was gathered.
•
15 of the 42 participants completed and returned the post-retreat distress tools for a return rate of 35%.
CFR offers free 2 ½ day retreats for 14 participants, the maximum number
recommended for educational, psycho-social, and small group dynamics.
The mean pre-retreat distress score was 4.02. Distress scores above 4 indicate emotional distress in need of treatment and/or
referral (National Comprehensive Cancer Network, n.d.)
• Retreats are held in heated lodges that accommodate the participants in
The mean post-retreat distress score was 2.93, a significant decrease in emotional distress. This is even more significant given
21 participants showed scores 4 or higher pre-retreat and only 3 participants had scores of 4 or higher post-retreat.
comfortable rooms. The scenic rural grounds include a pond or stream for fly
fishing, hiking trails, comfortable meeting areas, dining and bathing facilities,
and other amenities.
Problems were tabulated from both the pre- and post-retreat tools. The top 5 problems listed by participants were: 1) Worry,
fears, and nervousness 2) Fatigue 3) Memory and concentration 4) Sadness and depression and 5) Sleep.
• CFR offers free 2 ½ day retreats for 14 participants, the maximum number
recommended for educational, psycho-social, and small group dynamics.
Clinical Implications
• Retreats include food and lodging, roommate assignments, fly fishing
instruction, gear fittings, lessons on fly tying and entomology, time for reflection
and bonding, one-on-one guided fishing, and facilitated small group counseling
and medical education sessions.
Quality of life and distress data from this study is valuable in planning future cancer survivorship programs.
This study will be replicated with CFR participants in 2012 with the goal of obtaining information from a larger population from more
states with a higher return rate.
• In 2011, 47 retreats in 33 states served over 650 survivors; by the end of 2011,
CFR had served over 5,000 women since 1996 (CFR, n.d.)
Casting for Recovery is a valuable program to reduce and/or identify emotional distress and improve quality of life
in breast cancer survivors.
Demographics
The NCCN Distress tool may be better understood if it were renamed the “Emotional Distress Tool” in order to help cancer survivors
and staff understand what is meant by “Distress.”
Oncology nurses can use the Distress tool in clinical settings to provide cancer care for the whole person including psycho-social
assessment, interventions, and referrals as recommended by the Institute of Medicine. (Adler & Page, 2008).
Note: Distress tool used with permission in the study on 3/21/2011 and in this poster from the NCCN on 9/4/2012.
The 42 completed pre-retreat distress tools were collected at the national
CFR office. Original data was shredded by the CFR study after the study
was completed.
47 participants from five states participated in the survey: 7 from
California, 10 from North Carolina, 10 from Ohio, 11 from South
Carolina, and 9 from Texas. However 5 surveys had missing distress
scores and were not tabulated in the final N=42
The mean age of participants was 55.2 years. The mean number of
years since diagnosis was 5.02.
Author Contact: [email protected]
The number circled by participants on the distress thermometer was
considered the pre-test score.
Items checked by participants from the problem lists on the right side of
the tool were also tabulated.
The 42 participants received another mailed distress tool to complete 2
weeks following the retreat with stamped return envelope.
References
1. Adler, N.E., & Page, A.E.K. (Eds). (2008). Cancer care for
the whole patient: Meeting psychosocial health needs.
Washington, DC: National Academies Press.
2. American Cancer Society (2012). Breast cancer facts and
figures 2011-2012. Retrieved from:
http://www.cancer.org/acs/groups/content/@epidemiologysur
veilance/documents/document/acspc-030975.pdf
3. Casting for Recovery. (n.d.) Retrieved from:
http://www.castingforrecovery.org
4. NCCN. (n.d.) Distress guidelines. Retrieved from:
http://www.nccn.org
Acknowledgements
The author would like to acknowledge the following for
their help in making this research possible:
• Kate Fox, Lori Simon, & the administrative staff at
Casting for Recovery
• Debbie Hampton, CFR Ohio Coordinator, volunteer staff
and participants from the CFR program
• University of Cincinnati and Northern Kentucky University
Doctorate of Nursing Practice Programs
• National Comprehensive Cancer Network
Prevalence of Mental Health Issues
in People with Cancer
• _____ percent (or more) of all people
diagnosed with cancer have significant
psychosocial distress
• Less than 10% of these people actually are
identified and referred for help.
• The suicide rate among cancer patients is
___ that among the general population.
NCCN, 2010
Interventions to Manage
Emotional Distress
• Refer patients/caregivers to the Cancer
Support Community (a.k.a. Wellness
Community):
http://www.cancersupportcommunity.org
• Refer patients/caregivers to Cancer
Family Care
http://www.cancerfamilycare.org
Interventions to Manage
Emotional Distress
• Refer patients for spiritual/chaplain care
as desired by the patient
• Provide education and support to patients
& families, nurses are key! Use humor
freely, listen, don’t give “pity” looks
• Talk to patients about other areas of their
life, not just cancer; it’s about the person,
not the disease
Common Psychiatric Medications Used
in Oncology - Antidepressants
• SSRI’s- citalopram (Celexa), escitalopram
(Lexapro), fluoxetine (Prozac), fluvoxamine
(Luvox), paroxetine (Paxil), sertraline (Zoloft)
• SNRI’s- desvenlafaxine (Pristiq), duloxetine
(Cymbalta), venlafaxine (Effexor) , atomoxetine,
(Strattera), vilazodone (ViiBRYD)
• Others- mirtazapine (Remeron), nefazedone
(Serzone), trazodone (Oleptro), buproprion
(Wellbutrin)
Epocratesonline.com, 2012
Common Psychiatric Medications Used
in Oncology - Antidepressants
• Tricyclics- amitriptyline (Elavil), doxepin
(Sinequan), nortriptyline (Pamelor), protriptylene
(Vivactil), chlomipramine (Anafranil), imipramine
(Tofranil), desipramine (Norpramin),
trimipramine (Surmontil)
• MAOI’s- isocaboxazid (Marplan), phenezine
(Nardil), seligiline (Emsam), tranylcypromine
(Parnate)
Epocratesonline.com, 2012
Common Psychiatric Medications Used in
Oncology: Anti-Anxiety Medications
Lorazepam (Ativan)
Clonazepam (Klonopin)
Alprazolam (Xanax)
Diazepam (Valium)
Oxazepam (Serax)
Chlordiazepoxide (Librium)
Buspirone (Buspar) (non-benzodiazepine
anxiolytic)
Epocratesonline.com, 2012
Common Psychiatric Medications Used in
Oncology: Anti-Anxiety Medications
Off label anxiety medicationsPropranolol (Inderal) (beta blocker)
Hydroxazine (Vistaril or Atarax)
Diphenhydramine (Benadryl)
Epocratesonline.com, 2012
Common Psychiatric Medications Used
in Oncology: Sleep Aids
Zolpidem (Ambien)
Flurazepam (Dalmane)
Temazepam (Restoril)
Triazolam (Halcion)
Eszoplicone (Lunesta)
Ramelteon (Rozeram)
Zaleplon (Sonata)
Estazolam (Prosom)
Secobarbital (Seconal)
Chloral Hydrate
Off label sleep agents:
any of the
medications from the
anti-anxiety and
antidepressant slides,
as well as low dose
antipsychotic
medications
Epocratesonline.com, 2012
Less Common Psychiatric Medications
Used in Oncology: Antipsychotics
Atypicals/2nd or 3rd Generationaripiprazole (Abilify), asenopine (Saphris),
clozapine (Clozaril), iloperidine (Fanapt),
lurasidone (Latuda), olanzapine (Zyprexa),
paliperidone (Invega), quetiapine
(Seroquel), risperidone (Risperdal),
ziprasidone (Geodon)
Epocratesonline.com, 2012
Less Common Psychiatric Medications
Used in Oncology: Antipsychotics
1st Generation- chlorpromazine (Thorazine),
fluphenazine (Prolixin),
haloperidol (Haldol),
loxapine (Loxitane),
prochlorperazine (Compazine),
thioridizine (Mellaril),
thiothixene (Navane),
trifluoperizine (Stelazine)
Epocratesonline.com, 2012
Less Common Psychiatric Medications
Used in Oncology
• Mood Stabilizers/Bipolar Drugs
Valproic acid (Depakote), Carbemazepine
(Tegretol), Lamotrigine (Lamictal), Lithium
(Lithobid, Eskalith), Oxycarbemazepine
(Trileptal), Gabapentin (Neurontin),
Pregabalin (Lyrica)
Epocratesonline.com, 2012
Less Common Psychiatric Medications
Used in Oncology
• Stimulants & ADHD Medications
Dextroamphetamine (Adderall, Dexadrine),
Methylphenidate (Concerta, Desoxin, Ritalin,
Metadate, Methylin), Methylphenidate transdermal
(Daytrana), Dexmethylphenidate (Focalin),
Guanfacine (Intuniv), Dexedrine (ProCentra),
Lisdexamphetamine (Vyvanse), & Non-Stimulant
s-Clonidine (Catapres, Kapvay), Atomoxine
(Strattera)
Epocratesonline.com, 2012
Sexual Dysfunction Medications &
Resources for Cancer Survivors
• Erectile Dysfunction Medications & Devices
Tadalafil (Cialis), Vardenifil (Levitra), Sildenifil
(Viagra), Yohimbine (Yocon), Alprostadil urethralinjection, transurethral, (Muse, Edex, Caverject)
• SSRI’s that MAY cause sexual side effects
Citalopram (Celexa), Escitalopram (Lexapro),
Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline
(Zoloft)
Epocratesonline.com, 2012
Resources:
http://www.columbus.vc.ons.org/file_depot/0-10000000/010000/9206/folder/17505/2011%20Spring%20Conf%20Brixey.pdf
Link to 2011 Molly Brixey presentation slides with more sexuality
info/websites
Sexual Dysfunction Medications
• Products of Vaginal Dryness
Water based lubricants –KY jelly,
Astroglide, Liquid Silk, Replens
Hormones (unless ER+/PR+)-Vagifem (a
vaginal pill to use daily x 2 weeks then
twice/week), Estrogen creams, Premarin
Vaginal Dilators-for vaginal stenosis, use 34 times/week
Kegal exercies to improve Kegal muscle
strength
Brixey, 2011
Want to learn more about
assessment and management of
psychosocial distress?
Integrating Psychosocial Care Into Practice
Web Course - 8.5 CEUs: $69-ONS members; &
$100-non ONS members
http://www.ons.org/CourseDetail.aspx?course_id=87
https://www.epocratesonline.com for psychiatric
(and medical) medication photographs & patient
education materials
Last but not least - don’t forget to
manage your own distress!
My own Distress relief-ZUMBA!
Join us for a FUN event to raise
money for Mommy Has Breast
Cancer! All proceeds will go
towards helping local women
undergoing breast cancer
treatment.
Register online TODAY at
www.MommyHasBreastCancer.org
or get advance tickets from your
Zumba instructor!
$10 Advance ticket. $15 At the
door
Lakota Family YMCA
6703 Yankee Rd, Middletown
45044
(513) 779-3917