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PSYCHO-ONCOLOGY

dr. A.Jayalangkara Tanra, SpKJ, PhD

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PSYCHO-ONCOLOGY

Psycho-oncology mencoba mempelajaripengaruh kanker pada fungsi psikologisdan peranan variabel psikologis &

behavioral pada resiko kanker dankemungkinan bertahan hidup (Survivalrate).

Penelitian psycho-oncology mrp studiintervensi yang berusaha mempengaruhiperjalanan penyakit pasien kanker.

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Hasil penelitian dari David Spiegelmenyatakan bahwa seorang penderitakanker yang mendapat psikoterapi akanbertahan hidup lebih lama daripada yg

tidak. Sementara studi lain menemukanbahwa pemberian psikoterapi menurunkanangka rekurensi dan angka mortalitas

pada penderita kanker.

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Kurang lebih separuh dari pasien kanker

mengalami gangguan mental/kejiwaan.Gangguan mental yang paling seringdidiagnosis/ditemukan adalah :

- gangguan penyesuaian (68%)- gangguan depresif mayor (13%)

- delirium (8%)

- dll

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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%

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Medical conditions associated with delirium in cancerpatients :

Metabolic encephalopathy Vital organ failure

Electrolyte imbalance (such as hypercalcemia in patients withbony 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

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Causes of mood disorders common in cancerpatients :

Drugs- chemotherapeutic agents such as prednisone,

dexamethasone, vincristine, etc.

- additive effect of narcotics and many other drugs

known to cause depression, such asantihypertensives, benzodiazepines, etc.

Tumor effects

- hormone-secreting tumors

- central nervous system tumors

Associated medical conditions

- uremia

- viral encephalopathies

- electrolyte imbalances

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Reaksi-reaksi psikologis seseorang ygmengetahui bhw dirinya menderita kanker :

Fear of death, disfigurement, and disability

Fear of abandonment and loss of independence

Fear of disruption in relationships, role functioning, andfinancial standings

Denial, anxiety, anger, and guilt.

Walaupun pikiran dan keinginan bunuh diri sering

muncul pada pasien kanker, namun angka insidens-nya sedikit lebih tinggi daripada populasi

umum.

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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, characterpathology, 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

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Some examples of reasons forreferral

Anxiety Depression

Adjustment

Pain Grief

Difficulties with self image

Sexual dysfunction Relationship issues

Difficulties around treatment decisions

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Intervention strategies

(Knight, 2004)

Cognitive Behavioural Therapy (CBT) :Depression and conditioned aversiveresponses

Supportive and expressive therapies:exploration meaning, expression of emotion

Behavioural techniques: relaxation,

distraction, activity schedulingTraining in problem solving,

assertiveness, coping

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Kesimpulan

Dokter harus hati-hati dalam menilaitanda-tanda psikiatrik dan medik pada

setiap pasien kanker.

Perhatian khusus harus diberikan kepada

faktor keluarga, utamanya bila pernahterjadi konflik dalam keluarga, familyabandonment, dan family exhaustion.

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