PSYCHO-ONCOLOGY

dr. A.Jayalangkara Tanra, SpKJ, PhD

PSYCHO-ONCOLOGY
Psycho-oncology mencoba mempelajari pengaruh kanker pada fungsi psikologis dan peranan variabel psikologis & behavioral pada resiko kanker dan kemungkinan bertahan hidup (Survival rate). Penelitian psycho-oncology mrp studi intervensi yang berusaha mempengaruhi perjalanan penyakit pasien kanker.

Hasil penelitian dari David Spiegel menyatakan bahwa seorang penderita kanker yang mendapat psikoterapi akan bertahan hidup lebih lama daripada yg tidak. Sementara studi lain menemukan bahwa pemberian psikoterapi menurunkan angka rekurensi dan angka mortalitas pada penderita kanker.

Kurang lebih separuh dari pasien kanker mengalami gangguan mental/kejiwaan. Gangguan mental yang paling sering didiagnosis/ditemukan adalah : - gangguan penyesuaian (68%) - gangguan depresif mayor (13%) - delirium (8%) - dll

The Prevalence of Distress Rates range from 35% to 70% (depending on the study, country etc; e.g. Zabora et al, 2001, Carlson et al., 2004) Pain - 26% Anxiety - 24% Depression - 26% Fatigue - 49%

Medical conditions associated with delirium in cancer patients :

Metabolic encephalopathy Vital organ failure Electrolyte imbalance (such as hypercalcemia in patients with bony metastases or those receiving tamoxifen, diethylstilbestrol, or chlorotrianisene) Hypoxia (especially in patients with pulmonary involvement or severe anemia) Nutritional deficiencies (such as thiamine, folic acid, & B12) Infections (especially in immunosuppressed hosts) Vascular disorders (especially in patients with coagulopathies) Endocrine & hormonal abnormalities

Causes of mood disorders common in cancer patients :

Drugs chemotherapeutic agents such as prednisone, dexamethasone, vincristine, etc. additive effect of narcotics and many other drugs known to cause depression, such as antihypertensives, benzodiazepines, etc. Tumor effects hormone-secreting tumors central nervous system tumors Associated medical conditions uremia viral encephalopathies - electrolyte imbalances

Reaksi-reaksi psikologis seseorang yg mengetahui bhw dirinya menderita kanker :

Fear of death, disfigurement, and disability Fear of abandonment and loss of independence Fear of disruption in relationships, role functioning, and financial standings Denial, anxiety, anger, and guilt.

Walaupun pikiran dan keinginan bunuh diri sering muncul pada pasien kanker, namun angka insidensnya sedikit lebih tinggi daripada populasi umum.

Suicide vulnerability factors in cancer patients :

Depression and hopelessness Poorly controlled pain Mild delirium (disinhibition) Feeling of loss of control Exhaustion Anxiety Preexisting psychopathology (substance abuse, character pathology, major psychiatric disorder) Family problems Treats and history of prior attemps of suicide Positive family history of suicide Other usually described risk factors in psychiatric patients

Some examples of reasons for referral Anxiety Depression Adjustment Pain Grief Difficulties with self image Sexual dysfunction Relationship issues Difficulties around treatment decisions

Intervention strategies (Knight, 2004) Cognitive Behavioural Therapy (CBT) : Depression and conditioned aversive responses Supportive and expressive therapies: exploration meaning, expression of emotion Behavioural techniques: relaxation, distraction, activity scheduling Training in problem solving, assertiveness, coping

Kesimpulan

Dokter harus hati-hati dalam menilai tanda-tanda psikiatrik dan medik pada setiap pasien kanker.

Perhatian khusus harus diberikan kepada faktor keluarga, utamanya bila pernah terjadi konflik dalam keluarga, family abandonment, dan family exhaustion.