The objective of the DS12 study was to assess how a stressful event such as the diagnosis of cancer can affect the spousal relationship. The study used the Distress Thermometer (DT) and the Psychological Distress Inventory (PDI); our results show that narrative medicine for the couple can contribute to stress reduction.
Toward the end of the 1970s, the increased possibility of curing cancer influenced such disciplines as oncology, psychology, psychiatry as well as social and nursing care. Growing attention was given to psychological aspects and issues related to quality of life, survival, and rehabilitation. Consequently, the psychosocial approach to cancer has acquired an important role in its ability both to promote psychological health throughout the course of the disease and to improve the adjustment process in cancer patients. The aim of this article is to reconsider psychosocial approach in psycho-oncology, starting from the multidimensional definition of quality of life to the most recent data regarding the spiritual dimension as it is expressed in transpersonal psychology and in mindfulness interventions.
In women with early breast cancer, the carriers of the genetic polymorphism variants of serotonin transporter (5-HTTLPR) conferring low functional activity displayed high anxious preoccupation as mental adaptation to cancer (MAC) at follow-up. Therefore, we examined the role of the genetic polymorphism VNTR of monoamine oxidase-A (MAO-A) in the same patients. Mental adaptation to cancer was assessed using Mini-MAC scales at recruitment and at followup after 3 months. VNTR polymorphism of MAO-A was determined from blood or oral mucosa samples using conventional laboratory procedures. Women with the low-functionality activity MAO-A variant displayed significantly less anxious preoccupation at follow-up, as compared to the highly functional ones. No statistically significant effects of VNTR genotype and time were observed for the other subscales of Mini-MAC. The genotyping of women with early breast cancer for MAO-A VNTR, in addition and together to that for 5-HTTLPR, may allow the identification of the subjects that are likely to display a reduced reduction of their initial anxious preoccupation at follow-up. Interventions may be thus be aimed at the subjects in greater need of support. In the case of drug therapy, these results may allow the choice of the drug with the most appropriate mechanism of action and pharmacogenetic properties.
Before tumor diagnosis, stressful life events experienced by women with breast cancer are associated with the later development of depressive condi- tions; 5-HTTLPR does not play any significant role. After tumor diagnosis, mental adaptation to cancer is characterized in women with early breast cancer by anxious preoccupation which spontaneously decreases at follow-up; the reduction is significant only in the carriers of the "l/l" 5-HTTLPR genotype. Antidepressants act on depres- sion and mental adaptation to the disease, and the response is genotype dependent. 5-HTTLPR has therefore a role in psycho-oncology, permitting the identification of patients with greater need of support (carriers of "s/s" genotype), and in the case of drug treatment allowing the personalized choice of the drug (benzodiazepines for treating anxiety, or non-SSRI ADs for treating depression in "s/s" patients). Alto- gether, these data are in agreement with the more recent non-oncological reviews, showing a real, though small, effect of 5-HTTLPR on environmental adversity and the action of SSRI antidepressants.
In Western countries, colorectal cancer (CRC) is the third most common type of cancer in terms of incidence and mortality, after breast cancer in women and lung cancer in men. Rectal cancer (RC) comprises 30−40% of CRC cases. After the introduction of multimodal treatment and the development of the surgical techniques, long-term survival is improving. Considering the importance of the functional and anatomical complexities related to RC, the goal of treatment comprises long-term functional outcomes and monitoring of distress and quality of life (QoL) of patients. Like other cancers, symptoms at diagnosis, toxicity of treatments, and impact of surgery are different for each patient. This article describes what patients face and express during their treatment programs and what defines the care pathway that best supports their disease-related experience. Patients showed interest and appreciation for the administration of QoL questionnaires, and they reported feeling reassured by being followed by a complete and coordinated team. This efficient therapeutic alliance may result in less psychological distress for these patients.
Addressing the concerns, problems and changes within roles and family relations and encouraging the development of more adaptive ways of coping with psychosocial stress symptoms are the main aims of psychosocial intervention for cancer patients. Among the multiplicity and complexity of psychotherapy theories and models, cogntive-behavioral intervention, interpersonal psychotherapy and psychodynamic therapy, supportive-expressive therapy, and some new models, namely meaning-centered psychotherapy and dignity therapy, represent the most significant approaches in psycho-oncology.
This review describes the family interpersonal dynamics due to the onset, the course and the outcome of cancer as well as a psychological treatment program for the family caregivers. The literature concerning the family environment of cancer patients highlights two issues: the first concerns the change in relationship patterns in the family as well as in the context of care, the second refers to the psychological and/or psychopathological consequences for the caregivers. These clinical features consist of adjustment disorders and post-traumatic syndromes often observed in the caregiver and in the patient's children. The structure itself of family relationships is negatively affected by the disease. Role conflicts, increasing communication deviances, social isolation, disorganized or enmeshed relationships are described. The knowledge of these processes suggests to schedule tailored psychological support programs for the patient's partner and the families. These interventions are aimed at improving the active collaboration between family, patient and medical team as well as at supporting the family during the critical phases of the disease and of cancer treatments. A treatment program, including a counselling module, called "Family Psychoncological Counseling" and a psychotherapeutic module, called "Phasic Family Therapy," is described.
Following the indications and recommendations of associations, institutions, and councils around the world, psycho-oncology should have a "mandatory" function in programs within the health system, with particular references to oncology. The steps in the development of psycho-oncology services and/or units; their functions in terms of clinical, educational, and research activities; the standards that should be respected; and the organizational characteristics are discussed. With regards to this, the experience of Southern Europe and countries, specifically the models developed in Ferrara, Italy and Lisbon, Portugal, are presented. The objective of psycho-oncology, namely that no cancer health is possible without taking into consideration mental health, and, consequently, it is not possible to provide cancer care without a specific investment in the psychosocial area, represents the challenge for the health system.
In this study, we analyzed the main psychological and psychosocial issues of cancer, namely emotional distress, body image, sexual functioning, interpersonal relationships, cognitive functioning, cancer-related fatigue, and posttraumatic growth. For each aspect, we supply definition and prevalence data. We also investigated potential moderators and mediators, and here we discuss assessment instruments updated reviews and refer to recent international literature. In conclusion, we discuss the clinical and research implications of a "comprehensive" care approach to cancer patients.
The evaluation of psychiatric disorders related to cancer has been the subject of intense research in psycho-oncology. Psychopathological disturbances have an average prevalence of 35−45% and may be classified as "classical" psychiatric disorders (e.g., adjustment, anxiety, depressive disorders) and neuropsychiatric disorders (e.g., cognitive disorders secondary to treatment, delirium). Several problems have emerged in using the most common nosological systems, such as the International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM), because of their limits in specificity and sensitivity and in catching certain clinically significant dimensions (e.g., health anxiety, demoralization, irritable mood), which can be identified through other systems, such as the Diagnostic Criteria for Psychosomatic Research. The need to monitor psychosocial morbidity (i.e., "caseness") in cancer has determined the development of screening tools that have shown good levels of sensitivity and specificity. Among the psychopathological conditions that are strongly related to biological factors, the most common are cognitive disorders secondary to treatment (so-called chemo-brain) and delirium. The knowledge of the risk factors for both psychiatric and neuropsychiatric syndromes, including some specific problems, such as suicide, should be part of the training of healthcare professionals working in cancer centers. Furthermore, the barriers that still prevent comprehensive care to cancer patients should be identified and overcome.
The prevalence of Parkinson's disease (PD), the second most common neurodegenerative disorder, is increasing day by day and poses a great threat to the elderly population. Its main neuropathological feature is the loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc). However, the pathogenesis of PD is not understood fully. Clinical, experimental, microanatomic, and biochemical evidence suggest PD involves multifactorial oxidative neurodegeneration. The SNpc is uniquely vulnerable to oxidative damage, having a high content of oxidizable dopamine, neuromelanin, polyunsaturated fatty acids, and iron, and relatively low antioxidant complement with high metabolic rate. The aim of this review is to bring out the incidence of PD in India compared to that of Europe. Since ancient times plants have been valued for their medicinal properties, and many cultures still rely on plants as their major source of medicine. In this review we discuss the role of Indian medicinal plants in countering free-radical damage and also give you a glimpse about the clinical and pathological features of PD, available treatments, their drawbacks, and future challenges to overcome PD.
In childhood and adolescence, cancer has a 100 times lower incidence rate than in adulthood and higher probabilities of cure (approximately 80%). These results are achieved through intensive treatments delivered in qualified medical centers in which identical protocols are applied. For a number of years, treatment has included structured care, provided by expert multidisciplinary teams, for the developmental needs of children and adolescents and for their and their families' quality of life. Nevertheless, the lengthy uncertainty about the outcome, apart from implying relevant psychological costs, can cause emotional reactions that prevent patients from getting over the experience if they are cured, and from preserving quality of life if the disease worsens. The main issues of a child's or an adolescent's cancer experience, concerning objective aspects (e.g., hospitalization and therapy) and subjective ones (e.g., self-image, fears, anxieties, hopes), are reviewed here. The need for and ways to establish a direct therapeutic relationship with the child or adolescent from diagnosis are outlined. The psycho-oncologist cooperates in the comprehensive care, based on open and honest communication, and performs specific interventions at different levels: prevention, support, and psychotherapy. Settings are flexible according to each patient's needs, as they arise in the care-giving experience, and individual and family resources and fragilities are fully respected.
Oncology represents one of the areas of medicine where the emotional burden can be particularly high and where, as a consequence, health workers are at a higher risk of burnout. The relationship between the health worker and the patient is especially stressful; the relationship with the sick individual, with their family and with the issues related to the disease requires high levels of technical and psychosocial skill on the part of health workers. In this article, difficulties that health workers encounter during their work and in their relationships with oncology patients, as well as the importance of training as a tool to both improve the quality of health care and to prevent burnout, with the consequent positive impact on the quality of life of health workers, are considered.
The medications known as antidepressants are the group of psychotropic drugs used most often in psycho-oncology for their wide spectrum of action, ranging from mood improvement to the control of anxiety and pain. Antidepressants are drugs that act on the whole body rather than just the central nervous system. They also modulate the hormonal and immune systems, particularly normalizing stress-induced alterations. In oncology, the choice of an antidepressant must involve consideration of the symptoms and the dimensional aspects more than strict diagnostic criteria. A careful evaluation of the balance between effectiveness and safety, considering the possibility of interactions between antidepressants and oncological treatments, is crucial. In that context, this paper discusses each class of antidepressant relative to the present research literature concerning the specific use of each drug in oncological patients, noting that criteria of effectiveness and safety can differ from those established for the general psychiatric population without organic comorbidity. Finally, some aspects of the use of antidepressants in the treatment of patients with pain will be discussed, as these drugs exert an intrinsic antalgic activity even when depressed mood is not present. Indeed, antidepressants act not only on the somatic modulation of pain, but are also effective on the emotional and cognitive aspects of pain, therefore intensifying the analgesic activity of traditional painkillers.
