Hani hamed dessoki wpa 2013, cancer breast
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  • 1. Coping Strategies and Mental Disorders among Patients with Recurrent Breast Cancer Presented by: Hani Hamed Dessoki Prof. of Psychiatry Chairman of Psychiatry Department Beni-Suef University Authors: Fatma Moussa*, Hani Hamed**, Akmal Moustafa ***, Noha Abdel Shafi**** *Prof. of Psychiatry- Cairo Universitv, **Assist. Prof. of Psychiatry- Beni-Suef University- Beni-SuefEgypt, ***Assist. Prof. of Psychiatry- Cairo University, ****Assist. Prof. of Radiodiagnosis- National Cancer Institute-Cairo Universityt Vienna, WPA October, 2013
  • 2. Disclosure  I have no significant financial or other relationship with the manufacturer of any product or service I intend to discuss.  The following information dose not contain clinical trial.
  • 3. Introduction  Coping has been defined as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or "exceeding the resources of the person (Lazarus and Folkman, 1984).  Coping may be positive (adaptive or constructive coping) or negative.
  • 4. Introduction  One positive coping strategy, "anticipating a problem is known as proactive coping." It "reduce[s] the stress of some difficult challenge by anticipating what it will be like and preparing for how [one is] going to cope with it (Giuliano et al., 2011).  While adaptive coping methods improve functioning, a maladaptive coping technique will just reduce symptoms while maintaining and strengthening the disorder.
  • 5. .Introduction cont  Cancer survivors may experience a battery of sequelae in their survivorship, including physical discomfort and psychological concerns, such as uncertainty over the future and persistent fear of recurrence (Vickberg 2001).  In fact, one of the most frequently mentioned components of distress among cancer survivors is fear of recurrence, even though there are no signs of disease and it is one of the greatest psychosocial stressors confronting survivors and families (MacBride and Whyte 1998).
  • 6. .Introduction cont  All the patients reported fear of the future, particularly in relation to death and knowing that cancer had returned was devastating because they were not prepared for this shock, although they knew the chances of recurrence.  However, those with previous recurrence were not surprised by the diagnosis and were optimistic about a remission.  Thus, there is evidence that recurrence is a critical point in that it means that the cancer has not been controlled and may be uncontrollable in the future (Mahon et al.,1990).
  • 7. .Introduction cont  Thus, depression can be a complicating problem for a substantial minority of people with chronic medical illnesses, including cancer (Hegel et al., 2008).  The relationship between cancer and depression is bi-directional.  More rapid progression and increased symptoms of cancer are associated with more severe depression, (Van et al., 2008), while comorbid depression is associated with increased functional impairment and poorer quality of life over the course of chronic illness (Van et al., 2008).
  • 8. .Introduction cont  As cancer treatment improves, the disease is being converted from a terminal to a chronic illness.  Half of all people diagnosed with cancer will live to die of something else, so more people are living to cope with the disease, its treatment, the threat of recurrence and complicating psychiatric disorders.
  • 9.  To assess the relation between mental disorder and recurrence of breast cancer including mood symptoms and anxiety symptoms.  To detect the effect of coping strategies on recurrence of breast cancer.  To detect the impact of disturbed body image due to the recurrence of breast cancer.  To study the impact of recurrence on the quality of life containing its different aspects.
  • 10.  This study is a comparative case-control study aiming at assessment of the psychiatric co-morbidities in patients suffering from recurrent breast cancer. Subjects:  Subjects included in the study are 100 female patients; all are recruited consecutively from diagnostic radiology department (mammogram and ultrasound unite) in the National Cancer Institute Cairo University. Divided into 2 groups: Group A and B.
  • 11. Group A:  Consists of 30 patients who previously have diagnosed as recurrent breast cancer and coming to radiology department for follow up. Group B:  Consists of 70 patients who are referred for diagnostic radiology department (mammogram and ultrasound unite) follow up after radical mastectomy. These 70 patients will be assessed before having the radiology results. After completing the battery included in this study subjects in group B will have their mammogram and ultrasound, subsequently they will be divided into 2 groups
  • 12. Group B1:  18 patients who were discovered that they have a recurrent breast cancer on follow up with radiology. Group B2:  52 patients who didn't have a recurrent breast cancer on follow up with radiology.  Groups B1 and B2 will be compared statistically with group A for evidence of anxiety and depression revealed by the study tools. Informed consent:  A written informed consent was taken from patients after discussing with them the aim of the study.
  • 13. Procedure  The patient’s interviews were done twice per week (from November 2010 till November 2011).  Each patient was interviewed twice in the same week.
  • 14. All participants were subjected to the following: I-Present State Examination: (Wing et al., 1974)  Clinical assessment using the semi-structured interview of Present State Examination (PSE) which is useful for clinicians and researchers in  screening the subjects with psychiatric disorders and those who present with subclinical morbidity
  • 15. II-Psychometric tools: 1- Hamilton depression rating scale (HDRS) (Hamilton, 1960) (Arabic version, Futtaim ,1998): 2-Hamilton anxiety rating scale (HAM-A) (Hamilton, 1959) (Arabic version Futtaim ,1998): 3- Body Images Scale (Shoukaire, 2002): This scale is self rated, formed of 26 items every one of the subject answers in 3 grades from totally accepting to totally not accepting with score from 0 to 2 for each item. Normal range for males is (14 + 6) and for females (16 + 6) above which the body image is considered disturbed.
  • 16. 4- Coping Processes Scale (Ibrahim, 1994):  This scale is self rated, every one of the subjects answers in four grades to each phrase from totally accepting to totally not accepting. Each one of the 11 coping processes has certain phrases and each phrase take score from 1 to 4 then the total score for each process is calculated.
  • 17. 5-European Organization for Research and Treatment of Cancer 30-item core quality of life questionnaire (EORTC QLQ C-30) (Aaronson et al., 1993) Arabic version (Manal et al, 2008). The QLQ-C30 is a 30-item self-report questionnaire covering functional and symptom related aspects of QOL for cancer patients. It is grouped into five functional subscales (role, physical, cognitive, emotional and social functioning). In addition, there are three multi-item symptom scales (fatigue, pain, and nausea and vomiting), There are three versions 1.0, 2.0 and 3.0.
  • 18. V - Radiology Study (mammography and ultrasound) : Statistical analysis  All collected questions will be revised for completeness and logical consistency. Results were evaluated statistically by the Statistical Package for the Social Sciences (SPSS) version 20. Data were entered in a master table and categorical data were coded.
  • 19. Results  There were no statistically significant differences between the three groups as regards the sociodemographic data including age, marital status and education, but there were statistically significant difference as regard the occupation which means good matching for the groups.
  • 20. 1) Comparison between the three groups A, B1 and B2 as regards Hamilton depression rating scale (HDRS) Hamilton Group A depression rating n = 30 Group B B2 n = 18 scale (HDRS) B1 n = 52 P >0.000* Mean 43.00 27.11 23.96 Standard deviation + 8.00 + 5.87 +7.41
  • 21. The degree of severity of Hamilton Depression rating scale in the three groups Hamilton depression rating scale Group A n = 30 Group B Group B1 no=18 Group B2 no=52 No. % No. % No 0 .0 0 .0 4 7.7 Mild 0 .0 1 5.6 12 23.1 Moderate 0 .0 3 16.7 4 7.7 Severe 30 100.0 14 77.7 32 61.5 Total 30 100.0 18 100.0 52 100.0 P % Normal Chisquare 20.672 0.002*
  • 22. 2) Comparison between the three groups A, B1 and B2 as regards Hamilton Anxiety rating scale (HARS) Hamilton anxiety Group A rating scale Group B B1 n = 18 (HARS) B2 n = 52 P >0.000* n = 30 Mean 39.13 32.22 31.44 Standard deviation +7.19 + 6.68 +7.91
  • 23. 3) Comparison between the three groups A, B1, B2 as regard the Coping Processes Scale Coping process scale Group A n = 30 Group B Group B1 n = 18 Group B2 n = 52 No. % No. % Low 0 0.0 0 0.0 0 0.0 1 3.3 8 44.4 19 36.5 High 29 96.7 10 55.6 33 63.5 Total Mental disengagement No. Normal Helplessness % 30 100.0 18 100.0 52 100.0 Low 0 0.0 0 0.0 0 0.0 Normal 1 3.3 8 44.4 13 25.0 High 29 96.7 10 55.6 39 75.0 Total 30 100.0 18 100.0 52 100.0 P 0.001* 0.003*
  • 24. 3) Comparison between the three groups A, B1, B2 as regard the Coping Processes Scale (cont.) Coping process scale Group A n= 30 Group B Group B1 n = 18 Group B2 n = 52 P No. % No. % Low 0 0.0 0 0.0 0 0.0 Norm al 8 26.7 4 22.2 17 32.7 22 73.3 14 77.8 35 67.3 Total Positive reinterpretation No. High Information & social support % 30 100.0 18 100.0 52 100.0 Low 0 0.0 0 0.0 0 0.0 Norm 0 0.0 0 0.0 3 5.8 0.662 0.240
  • 25. 3) Comparison between the three groups A, B1, B2 as regard the Coping Processes Scale (Cont.) Coping process scale Group A n = 30 Group B Group B1 n = 18 Group B2 n = 52 No. % No. % Low 0 0.0 0 0.0 1 1.9 Normal 13 43.3 13 72.2 42 80.8 17 56.7 5 27.8 9 17.3 Total Turning To religion No. High Wishful thinking % 30 100.0 18 100.0 52 100.0 Low 0 0.0 0 0.0 0 0.0 Normal 9 30.0 5 27.8 10 19.2 High 21 70.0 13 72.2 42 80.8 Total 30 18 100.0 52 100.0 P 0.006* 0.501
  • 26. 3) Comparison between the three groups A, B1, B2 as regard the Coping Processes Scale (cont.) Coping process scale Group A n = 30 Group B Group B1 n = 18 Group B2 n = 52 No. % No. % Low 0 0.0 0 0.0 0 0.0 Normal 5 16.7 4 22.2 30 57.7 25 83.3 14 77.8 22 42.3 Total Acceptance No. High Emotional discharge % 30 100.0 18 100.0 52 100.0 Low 0 0.0 0 0.0 0 0.0 Normal 9 30.0 7 38.9 29 55.8 High 21 70.0 11 61.1 23 44.2 Total 30 100.0 18 100.0 52 100.0 P 0.000* 0.066
  • 27. 3) Comparison between the three groups A, B1, B2 as regard the Coping Processes Scale (cont.) Coping process scale Group A n = 30 Exercite restrain Denial Active coping Low Normal High Total Low Normal High Total Low Normal High Total No. 8 15 7 30 0 3 27 30 0 8 22 30 % 26.7 50.0 23.3 100.0 0.0 10.0 90.0 100.0 0.0 26.7 73.3 100.0 Group B Group B1 Group B2 n = 18 n = 52 No. 3 12 3 18 0 1 17 18 0 6 12 18 % 16.7 66.7 16.7 100.0 0.0 5.6 94.4 100.0 0.0 33.3 66.7 100.0 No. 4 39 9 52 0 16 36 52 0 43 9 52 % 7.7 75.0 17.3 100.0 0.0 30.8 69.2 100.0 0.0 82.7 17.3 100.0 P 0.145 0.018* 0.000*
  • 28. Quality of Life Scale in Three Groups  There are no statistically significant differences regarding all domains of quality of life scale between the three groups.
  • 29. Positive Correlation Hamilton anxiety and depression rating scale emotional discharge
  • 30. Conclusion  There is high frequency of psychiatric co-morbidities (especially anxiety) in recurrent breast cancer patients.  The presence of psychiatric co-morbidities increases the impairment in quality of life in recurrent breast cancer patients.  The breast cancer patients used certain strategies to cope with their illness and the presence of anxiety and depression modifies the coping mechanisms used by them.
  • 31. Recommendation  Adequate referral system which ensures prompt referral of recurrent breast cancer patients in oncology inpatient and outpatient clinics to the liaison psychiatry clinic for early detection of psychiatric manifestations and proper management.  Implementation of educational programs for the working staffs (Doctors and nurses) in oncology to enhance the importance of screening for psychiatric disorders using simplified assessment scales.
  • 32. Limitations  Longitudinal study is needed for assessment of the psychological state of the patients when they knew to have cancer breast.  Larger sample is needed for better comparison after subdivision of the groups.