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December 2008 Issue

Pilot study collaborators include (from left to right): Carol Huber, of Cancer Family Care; Shannon Offerman, MD, radiation oncology resident; Ruth Lavigne, MD, assistant professor; and Carla Williams, a psychiatry consultant.
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Psychosocial Needs Being Addressed for Newly Diagnosed Breast Cancer Patients

By Amanda Harper
Published December 2008

After a cancer diagnosis, the immediate focus is on medical needs for recovery.

But in the whirlwind of treatments, many patients say their psychological and social needs (referred to as psychosocial factors) are often overlooked—both by themselves and their physicians.

According to Institute of Medicine research, many physicians do not address the psychosocial health needs of patients as part of standard cancer care.

UC physicians say this is a major problem that needs immediate attention.

Patients recovering from cancer absorb a great deal of physical, mental and social changes. Diagnosis is just the first hit. As patients transition back into “normal” life, they realize things have changed.

Anxiety, fear and high expectations from family and work can cause additional stress.

“Depression starts a vicious cycle that is hard to break without intervention,” explains Ruth Lavigne, MD, a UC assistant professor and radiation oncologist at the UC Barrett Cancer Center at University Hospital.

“Patients feel ill, so they don’t eat well and can’t make up the calories treatment is sapping out of them. This can lead to a poor sense of well being and a failure to thrive.

“I believe the majority of patients who don’t show up for their regular treatments are showing signs of depression,” Lavigne adds.

“As they become consumed by the side effects of the disease, they end up denying themselves the medical treatment they need to get well.”

Lavigne is leading a multidisciplinary pilot study to screen newly diagnosed breast cancer patients for signs of depression. The goal is to intervene early so that the patient’s psychosocial needs can be addressed before they become detrimental to overall quality of life.

The research project is a collaboration of UC’s departments of radiation oncology and psychiatry, the Barrett Cancer Center and Cancer Family Care, a nonprofit organization that provides counseling, education and emotional support to people affected by cancer or cancer- elated death.

For this study, newly diagnosed breast cancer patients are given a 12-question survey to screen for signs of depression several times: at the beginning of radiation treatment, the conclusion of treatment and during the two-week and three-month follow-up visits.

The survey gauges a patient’s mental and physical well being. Personal interactions with the physician will also be taken into account when deciding whom to refer for counseling services.

Researchers say the goal is to determine how best to identify patients at risk for depression and create a screening protocol that will allow for early intervention.

“We’re focused on treating the whole patient and understanding how their mental state of mind impacts physical health,” says Carla Williams, a research consultant in the psychiatry department.

“The goal is to help patients and family members get through the psychosocial challenges of a chronic illness while improving their overall quality of life.”

“Studies have shown there is a connection between mental and physical health,” says Carol Huber, director of clinical services at Cancer Family Care. “Cancer treatment makes a lot of patients feel awful, but the worst typically happens during and after treatment because the patient is tired, stressed and dealing with changing relationships.

“Once these women are referred to Cancer Family Care, they are exposed to additional programs and services that improve their quality of life, such as free wigs and massage therapy,” Huber adds.

Patient Roman Kassahun says dealing with the aftereffects of cancer treatment left her feeling like she didn’t know who she was anymore.

“I’m 49, but cancer treatment makes me feel like I’m 65,” she says. “My body is not the same as it used to be. My joints hurt; I can’t wear high heels. I get tired easily. Sometimes I have such awful head and body aches I don’t even want to get out of bed.”

Kassahun began seeing social worker Mary Ann Heekin once a week on recommendation from Lavigne, who had screened her for depression as part of the pilot study.

Kassahun says Heekin helps her focus on her goals—both long and short term—and offers support and advice in dealing with the side effects of treatment.

“It’s hard to accept the ‘new you,’ but you have to tell yourself to go forward. The cancer is gone but the pain still holds me back,” Kassahun adds. “I’ve realized you can’t put your life back together on your own after cancer. You can’t bear every burden alone.”

Study participants who demonstrate warning signs of depression are referred to Cancer Family Care for follow-up counseling at no cost.

Since the study began, 35 percent of women in the study have tested positive for depression.

“So far we are seeing that women are more likely to show signs of depression as they get further in the treatment process,” adds Shannon Offerman, MD, a radiation oncology resident and study collaborator.

“Women with depression seem to perceive more pain and poorer health compared to other women getting similar treatment.”

For more information on this study, call (513) 584-4073.

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