Psycho Social Problems of Head & Neck Cancer Patients

KUNNAMPALLIL GEJO JOHN BASLP,MASLP AUDIOLOGIST

KUNNAMPALLIL GEJO JOHN

Prevalence
Head and neck cancer is the 10th most common cancer in the world It accounts for 4% of all malignant cancers Concern in increasing in younger patients and in women The male/female ratio is less than 2:1 This gap is closing steadily.
KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

Prevalence
Men who smoke has decreased Young females who smoke increased 20% of H/N Patients will develop second or third primary tumor 80% to 90% of patients having history of smoking Alcohol is an independent risk factor

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

COMMON FEARS
DEATH DISSABILITY DISFIGERMENT DEPENDENCY DISTRUPTION OF ROUTINE ACTIVITIES
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COMMON REACTIONS TO CANCER

DEPRESSION
HOSTILITY ANXIETY GUILT COMPLIANCE DEPENDENCY
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COMMON LOSSES
LOSS OF HEALTH LOSS OF FRIENDS/LOVED ONES INABILITY TO PERFORM ROUTINE ACTIVITIES LOSS OF FINANCES LOSS OF SELF ESTEEM LOSS OF RELIGIOUS CONVICTIONS
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CANCER IMPACT
PHYSICAL SYMPTOMS PSYCHOLOGICAL SOCIAL FINANCIAL FAMILY WORK
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SPECIAL SOCIAL PROBLEMS

ANXIETY AND UNCERTAINITY MISCONCEPTIONS ABOUT CANCER INCREASING COST OF TREATMENT TRANSPORTATION ACCOMODATIONS FOR PATIENTS AND RELATIVES ALLIED PROBLEMS RELATED TO POVERTY LONG DISTANCE ETC.. KUNNAMPALLIL GEJO JOHN

MEANING OF DISEASE
Value Pain Challenge Enemity Punishment Weakness Relief Strategy Irreparable loss
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Concerns/Demands
Treatment Issues. Social Interaction & Support. Changes in Life Context or Perspective. Acceptance of the Illness. Sexuality. Feminine Self-Image.
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Acceptance of the illness

Difficulties during the early diagnostic phase The shock or trauma How it happened too fast why it never ends Wondering about the future
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Making Choices
Deciding what to do What Doctor, Second Opinion to trust. Which treatment regimen to choose.

KUNNAMPALLIL GEJO JOHN

Uncertanity
The process of waiting & Wondering Waiting-for test results Worrying about Cancer recurrence

KUNNAMPALLIL GEJO JOHN

Treatment Issues
Difficulties in interacting with the

Health care community Vying medical opinions Acquiring self-care skills

KUNNAMPALLIL GEJO JOHN

HOSPITALIZATION
Being hospitalized far away from home. Not having friends to visit. Having to eat cold or tasteless food. Strangers sleep in the same room. Having to sleep in a strange bed. Wearing hospital dress/Unusual smells. Having to be assisted with bed pan. Being fed through tubes. Family members being far away. Being in the hospital during holidays & special holidays.
KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

The psychological importance of voice

Voice is unique to the individual and can be central to a persons identity The loss of voice is more than loss of speech Voice is an extension of thought and persons sense of self.
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Problems pertaining to speech

Not being understood Not being able to make oneself heard in a noisy room Feeling inhibited in expressing,emotions such as anger, laughing, whispering , lack of volume Embarrassment about physical appearance
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Problems pertaining to swallowing

Problems with food intake Impairment of taste and sucking Mucous discharge Fear of intake of liquids

KUNNAMPALLIL GEJO JOHN

Other changes
Coughing,problems with hygiene Blowing nose,having frequent colds Breathlessness,less physical capacity Fear in covering stoma Self image

KUNNAMPALLIL GEJO JOHN

Psychological symptoms
Anxiety,uncertainty,depression,lost of self esteem ,suicidal thoughts ,uselessness Shame, irritability, fear of recurrence ,sense of inferiority. Vocabulary problems are common 20%-90% Social withdrawal and tension in relationship with partner absence or infrequency of sexual intercourse 8%-33%
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Sexual Problems
Physical limitations - Result from treatment Fears
Misinformation

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EMPLOYMENT
Loss of job Long leave Absenteeism Work problem Conflict with supervisors/co-workers Hostility from co-workers Less concern about carrier goals

KUNNAMPALLIL GEJO JOHN

FINANCIAL BURDEN
Loss of patients income. Loss of family Income Expenditure incurred --patients illness & Rx Expenditure incurred --extra arrangements. Loans taken or savings spent. Postponement of planned activity owing to financial pressure.

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

Fears and concerns of family members

Emotional strain Physical demands Fear of the patient dying Altered roles and life styles Finances Ways to comfort the patient Perceived in adequacies of services

KUNNAMPALLIL GEJO JOHN

NEED FOR REHABILITATION

Lead normal life To cope up with the illness To sustain treatment To adjust with family To re-plan resources

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

WHAT IS REHABILITATION ?
The process of enhancing restorations and maintaining optimal physical and psychological functioning.
Focuses on what a person has, instead of what he has lost and aims at helping a person learn to live with what he has.

KUNNAMPALLIL GEJO JOHN

GOALS FOR REHABILITATION

Physical Psychological

Social
Occupational / Vocational Family

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Rehabilitation Starts
Diagnosis Treatment (Multi-disciplinary) Post-treatment and Follow-up Terminal care

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Voice Rehabilitation

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

Interventions
Education Emotional support Individual Psychotherapy Supportive group therapy Sharing feelings Developing coping skills Considering existential issues
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FAITH

Faith in oneself Ones doctor Ones treatment Ones spiritual faith

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Support
THE MOST IMPORTANT MEDICINE IS TENDER LOVE AND CARE .
-Mother Teresa

KUNNAMPALLIL GEJO JOHN

each instrument is played harmoniously on the same score rather than same note

It is like a symphony where

Thank you

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN