Kanser Hastalarında Psikiyatrik Yaklaşımlar
Özet
Kanser, küresel yükü hızla artan ve tanı aşamasından itibaren bireylerde psikososyal yıkımlara yol açabilen organik, psikolojik ve sosyal bileşenleri olan bir hastalıktır. Kanser hastalarında psikiyatrik bozuklukların görülme sıklığı %29-47 arasında değişmekte olup; tanı, tedavi ve terminal dönemlerde depresyon, anksiyete, uyum bozukluğu, deliryum, cinsel işlev bozuklukları ve intihar düşünceleri gibi ciddi ruhsal tablolar ortaya çıkabilmektedir. Bu süreçte hastalar inkar, öfke, pazarlık, depresyon ve kabullenme gibi beş evreli yas tepkileri gösterebilir. Tedavi uyumunu artırmak, yatış sürelerini kısaltmak ve yaşam kalitesini optimize etmek adına bu semptomların mutlaka multidisipliner bir yaklaşımla ele alınması gerekmektedir. Tedavi süreçlerinde, hastanın durumuna ve yaş grubuna göre SSRI, SNRI grubu antidepresanlar ile kısa etkili benzodiazepinler gibi farmakolojik ajanlar düşük dozda başlanarak dikkatle titre edilmelidir. Bunun yanı sıra bilişsel davranışçı terapi (CBT), kabul ve kararlılık terapisi (ACT), anlam merkezli grup terapileri, gevşeme-nefes egzersizleri ve uyku hijyeni uygulamaları gibi farmakolojik olmayan destekleyici yöntemler de psikososyal onkolojinin ayrılmaz bir parçasıdır. Sonuç olarak, hastaların kaygılarını azaltmak ve uyum süreçlerini kolaylaştırmak için onkolog, psikiyatrist, psikolog, hemşire ve sosyal hizmet uzmanlarının işbirliği içinde çalışması zorunludur.
Cancer is a disease with organic, psychological, and social components that can cause psychosocial destruction in individuals starting from the diagnosis stage, and its global burden is increasing rapidly. The prevalence of psychiatric disorders in cancer patients varies between 29% and 47%; serious mental conditions such as depression, anxiety, adjustment disorder, delirium, sexual dysfunction, and suicidal thoughts may emerge during the diagnosis, treatment, and terminal phases. In this process, patients may display five-stage grief responses consisting of denial, anger, bargaining, depression, and acceptance. In order to increase treatment adherence, shorten hospitalization periods, and optimize the quality of life, these symptoms must be addressed through a multidisciplinary approach. In treatment processes, pharmacological agents such as SSRI and SNRI group antidepressants and short-acting benzodiazepines should be initiated at low doses and carefully titrated according to the patient's condition and age group. In addition, non-pharmacological supportive methods like cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), meaning-centered group therapies, relaxation-breathing exercises, and sleep hygiene practices are integral parts of psychosocial oncology. Consequently, cooperation among oncologists, psychiatrists, psychologists, nurses, and social workers is mandatory to reduce patients' anxieties and facilitate their adaptation processes.
Referanslar
Ergin I. Dünyada ve Türkiye’de güncel kanser istatistikleri. İçinde: Özentürk MG, editör. Kanser kontrolü ve disiplinlerarası yaklaşım. 1. Baskı. Ankara: Türkiye Klinikleri; 2021. s. 6-10
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer. 2015; 36:359-386.)
Ülger E, Alacacıoğlu A, Gülseren AŞ, et al. Kanserde psikososyal sorunlar ve psikososyal onkolojinin önemi. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi. 2014; 282: 85-92.
Özkan S. Psikiyatrik Tıp: Konsültasyon Liyezon Psikiyatrisi, İstanbul 1993.
Kübler-Ross E. Ölüm ve Ölmek Üzerine. İstanbul, Boyner Holding Yayınları, 1997.
Işıkhan V. Kanser ve sosyal destek. Toplum ve Sosyal Hizmet Dergisi 2007;1: 15-29.
Özkan S. Psiko-onkoloji. 1. Baskı, İstanbul: Form Reklam Hizmetleri, 2007.
Ateşçi, F. Ç., Oğuzhanoğlu, N. K., Baltalarli B., Karadağ, F., Özdel, O., & Karagöz, N. (2003). Kanser hastalarinda psikiyatrik bozukluklar ve ilişkili etmenler. Turk Psikiyatri Derg, 14, 145-152
Sette, C. P., Capitão, C. G., & de Francisco Carvalho, L. (2016). Depressive symptoms in patients with cancer. Open Journal of Medical Psychology, 5(1), 7-16.
Sadock, B. J., Sadock, V. A., Ruiz, P. (Ed.), (2017). Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 10th Edition., Lippincott Williams & Wilkins. s. 2250 - 2287.
Reed, S. C., et al. (2020). Fear of cancer recurrence and associations with mental health status and individual characteristics among cancer survivors: findings from a nationally representative sample. Journal of psychosocial oncology, 38(2), 125-142.
Guo, Y., Musselman, D. L., Manatunga, A. K., Gilles, N., Lawson, K. C., Porter, M. R., ... & Nemeroff, C. B. (2006). The diagnosis of major depression in patients with cancer: a comparative approach. Psychosomatics, 47(5), 376-384.
Carr D, Goudas L, Lawrence D, Pirl W, Lau J, DeVine D et al. Management of Cancer Symptoms: Pain, Depression, and Fatigue (Evidence Report/Technology Assessment No. 61). Rockville, Agency for Healthcare Research and Quality, 2002.)
Caruso R, Grassi L, Nanni MG, Riba M. Psychopharmacology in psycho oncology. Curr Psychiatry Rep 2013;15:393.
Thekdi SM, Trinidad A, Roth A. Psychopharmacology in cancer. Curr Psychiatry Rep 2015; 17:529.
Grassi L, Caruso R, Hammelef K, Nanni MG, Riba M. Efficacy and safety of pharmacotherapy in cancer related psychiatric disorders across the trajectory of cancer care: A review. Int Rev Psychiatry 2014;26:44 62.
Chaturvedi S. Clinical Psycho Oncology : Indian Perspectives and Research. 1st ed. Self-published by Dr Santosh K Chaturvedi: Amazon. com: Books; 2021
Hamann HA, Somers TJ, Smıth AW, Inslicht SS, Baum A. Posttraumatic Stres associated with cancer history and BRCA1/2 genetic testing. Psychosomatic Med 2005; 67: 766-772.
Lederberg MS. Psychooncology. In Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 8th Ed. (Eds. BJ Sadock, VA Sadock):2196-2225. Philadelphia, Lippincott Williams & Wilkins, 2005.
Sherman LK, Fisch MJ. Cancer and mood disorders. In Psychiatry Highlights 2003-4 (Ed M Lader):80-87. Albuquerque, Health Press, 2004
Li M, Fitzgerald P, Rodin G. Evidence based treatment of depression in patients with cancer. J Clin Oncol 2012;30:1187 96
Breitbart W, Rosenfeld B, Pessin H, Applebaum A, Kulikowski J, Lichtenthal WG. Meaning centered group psychotherapy: An effective intervention for improving psychological well being in patients with advanced cancer. J Clin Oncol 2015;33:749 54.
Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol 2005;23:5520 5.
Ando M, Morita T, Akechi T, Ito S, Tanaka M, Ifuku Y, et al. The efficacy of mindfulness based meditation therapy on anxiety, depression, and spirituality in Japanese patients with cancer. J Palliat Med 2009;12:1091 4.
Lo C, Hales S, Jung J, Chiu A, Panday T, Rydall A, et al. Managing Cancer And Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer. Palliat Med 2014;28:234 42
Bronner, M. B., Nguyen, M. H., Smets, E. M., van de Ven, A. W., & van Weert, J. C. (2018). Anxiety during cancer diagnosis: Examining the influence of monitoring coping style and treatment plan. Psycho‐oncology, 27(2), 661-667.
Mitchell, A. J., Ferguson, D. W., Gill, J., Paul, J., & Symonds, P. (2013). Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. The lancet oncology, 14(8), 721-732.
Bates, G. E., Mostel, J. L., & Hesdorffer, M. (2017). Cancer-related anxiety. JAMA oncology, 3(7), 1007-1007
Elbi H. Kanser ve psikiyatrik sorunlar. Ege Psikiyatri Sürekli Yayınları, 1997; 2:173- 187.
Jacobsen PB, Jim HS. Psychosocial interventions for anxiety and depression in adult cancer patients: Achievements and challenges. CA Cancer J Clin 2008;58:214 30
Barlow DH. Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. 2nd ed. New York: Guilford Press; 2002.
Silva, J. A. C. E., et al. (1996). Special report from a symposium held by the world health organization and the world federation of sleep research societies: An Overview of Insomnias and Related Disorders--Recognition. Sleep-Lawrence, 19(5), 412-416.
Yavuzşen, T., Alacacıoğlu, A., Çeltik, A., & Yılmaz, U. (2014). Kanser ve uyku bozuklukları Türk Onkoloji Dergisi, 29(3), 112-119.
Roscoe JA, Kaufman EM, Matteson SE, Palesh OG, Ryan JL, Kohli S et al. Cancer related fatigue and sleep disorders. Oncologist 2007; 12(suppl):35-42.
Howell D, Oliver TK, Keller-Olaman S, Davidson JR, Garland S, Samuels C, et al. Sleep disturbance in adults with cancer:A systematic review of evidence for best practices in assessment and management for clinical practice. Ann Oncol. 2014;25:791–800.
Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia:Update of the recent evidence (1998-2004) Sleep. 2006;29:1398–414
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
Bond SM, Neelon VJ, Belyea MJ. Delirium in hospitalized older patients with cancer. Oncol Nurs Forum 2006; 33:1775-1783.
Michaud L, Burnand B, Stiefel F. Taking care of the terminally ill cancer patient: Delirium as a symptom of terminal disease. Ann Oncol 2004; 15(Suppl 4):199-203
Kenneth D. Cognitive disorders: Introduction and overview. In Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 8th Ed. (Eds. BJ Sadock, VA Sadock):1054- 1068. Philadelphia, Lippincott Williams & Wilkins, 2005.
Packard RC. Delirium. Neurologist 2001;7:327-40.
Gagnon B, Low G, Schreier G. Methylphenidate hydrochloride improves cognitive function in patients with advanced cancer and hypoactive delirium: a prospective clinical study. J Psychiatr Neurosci 2005; 30:100-107.
Clegg A, Siddiqi N, Heaven A, Young J, Holt R .Interventions for preventing delirium in older people in institutional long-term care. Cochrane Database Syst Rev. 2014;
Pitkälä KH, Laurila JV, Strandberg TE, Tilvis RS .Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2006;61(2):176.
Twombly R. Decades after cancer, suicide risk remains high. J Natl Cancer Inst 2006; 98:1356-1358
Walker J, Waters RA., Murray G et al. Better off dead: suicidal thoughts in cancer patients. J Clin Oncol 2008; 26:4725-4730
Morreale, MK (2011) The impact of cancer on sexual function. Advances in Psychosomatic Medicine 31, 72–82.
Zhou ES, Nekhlyudov L, Bober SL. The primary health care physician and the cancer patient: Tips and strategies for managing sexual health. Transl Androl Urol 2015;4:218 31
Carter J, Lacchetti C, Andersen BL, Barton DL, Bolte S, Damast S, et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology clinical practice guideline adaptation of cancer care Ontario guideline. J Clin Oncol. 2018;36:492–511.
Perz J, Ussher JM, Gilbert E. Constructions of sex and intimacy after cancer:Q methodology study of people with cancer, their partners, and health professionals. BMC Cancer. 2013;13:270.
Tuncay T. Kanserle baş etmede destek grupları. Toplum ve Sosyal Hizmet 2010; 21. Sayı.
Montgomery C, Lydon A, Llyoyd K. Psychological distress among cancer patients and informed consent. Journal of Psychosomatic Research 1999; 46: 241-24
