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Atlantis Healthcare
Building unique support solutions for individual patient needs
• Shortens relapse and survival times (Partridge, 2006)
Interruption of imatinib therapy in patients with advanced GI stromal tumours (GIST) reduced two year progression free survival from 80% to 16% (Geynisman, 2013)
– Tangible feedback highlights the discrepancy (MEM)
– “White coat adherence”
• Increasing doses around doctor appointments
– well as it could”
“I’ve taken imatanib 600mg for a few years now. I knew I was missing days but I didn’t realize how much I was missing. I asked how much I’d actually been missing. It worked out that I’d been missing 20% of the doses over a 3 month period. So it wasn’t working quite as it could do”
• Problem-solving with healthcare professionals allowed patient to continue with therapy
– Its not whether you get side effects, but how you cope with them that’s important
“So they said we’ll bring your dose down to 400mg, make sure you take it every day. The side effects haven’t been quite so bad, so its been more manageable to do that”
• Distress is generally a normal response to a diagnosis, and the challenges that come up during and after treatment
• Patients can feel completely out of control both in terms of their emotions and their day to day life. Helping them to gain control in other places can be helpful for managing distress:– Firstly acknowledge the distress and normalise it – patients often think they are
the only ones distressed
– Anchoring patients to the consistent parts of their daily routine
– Getting patients to keep a weekly schedule so they know what is coming up
– Balance attention and distraction
– Self-care – Relaxation
– If talking it through is helpful, you can help the patient identify someone in their support network or a professional they can talk to
• Communicating with friends and family can be difficult when distressed or going through something difficult. Encourage patients to utilise social support in a way that is helpful for them:– This may require some assertive communication rather than the more common
passive “kiwi” communication e.g. “I need some space” or “I need some help”
– Reassure the patient that for the most part people supporting cancer patients like to be guided on what is helpful
• Some people don’t cope well with the ‘Big C’ and so pull away from a relationship when a friend is diagnosed with cancer. This can cause the patient a lot of distress:– Normalise the loss of a/some friend(s) so the patient knows it isn’t just them
– Acknowledge the grief that goes along with losing something/someone
– Gently bring the patients’ attention to who is there supporting them
• White coat effect – there is a power differential between doctor and patient. This makes it harder for some patients to communicate exactly what they want to say:
– Utilise general strategies for building rapport, i.e. eye contact, non verbal listening skills, not rushing the patient, collaborative decision making
• Patients take away about 5% of what is discussed in a consultation:
– Give summaries or written answers to their questions that patients can take away with them
– Try not to use jargon during the consultation – NZ has a low level of health literacy
– Check for patients’ understanding
• Patients vary on how much information is helpful for them to cope:
– Ask your patients if they are a blunter or a monitor and tailor the information you give
• Often GP support comes in once all the intensive treatment has finished. This is a time that cancer patients feel particularly vulnerable because they are no longer seeing their team of HCPs at the hospital weekly-monthly:
– Agreeing on a plan for management with the patient can help reassure the patient medical support is still there– not everyone will need the same level of input to feel supported
• Sexual difficulties are common during and after cancer treatment:– Impotence– Vaginal dryness– Bodily changes – losses/gains, scarring, baldness (all over!)– Loss of libido– Loss of confidence
NORMALISE: “Its common for people who have had cancer treatment to have difficulties with sex/intimacy/in the bedroom.”
ASK: “If it’s a concern for you, I’m happy to talk things through today and see what we can do to help.”
PROBLEM SOLVING: Medication, perceptions of intimacy, building confidence
• Anecdotally, patients feel in the dark about their prognosis:– HCPs won’t bring it up– Patients don’t want to know– HCPs anxious about giving an incorrect prediction– Disparate coping strategies – patients and carers
• NORMALISE: Be their advocate – offer to call the Specialist for them
• OPEN IT UP: “Are you worried if you are going to die?”
• REASSURE: “It must be really frightening for you.”
• BE PRACTICAL: wills, last wishes, guardianship, tying up loose ends
• CREATE A LEGACY: videos, letters, mementoes, creation of family rituals
• Causes of insomnia in primary care (Arroll et al., 2012)
– 19% of patients in the waiting room had primary insomnia– Of these:
• 50% (195) had depression• 48% (185) had anxiety• 43% (165) had general (physical) health problems.• 9% (34) had OSA• 2% (7) had delayed sleep phase disorder
– 15-30% of general population at any one time
• Sleep disturbance is very common amongst cancer patients:– Elevated anxiety, uncertainty– Effects of treatment– Pain, hot flushes…
1. National Comprehensive Cancer Network Barry D. Practice guidelines in oncology –V. 1. 2002: distress management: National Comprehensive Cancer Network, 2002
2. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psycho-Oncology 2001; 10: 19-28
3. Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L, et al. High levels of untreated distress and fatigue in cancer patients. British Journal of Cancer 2004; 90: 2297-2304