Forum 2017: Psychosomatic Care in Cancer: Empathy, Understanding and Communication

Title: Emotional Aspects of Cancer

A new cancer diagnosis or recurrence can result in various levels of depression or anxiety for adult, adolescent and child cancer patients, and their families. The distress can arise from a multitude of factors: from the diagnosis itself; potential or perceived disruptions to quality of life including family, work, school, finances, and relationships; responses from the social support system, including miscommunications, too little or too much information; direct or side effects from treatments, either primary or adjuvant; direct or indirect results of the cancer itself; current or past psychiatric history; etc.

Since patients also often have cancer-related pain, fatigue, and symptoms from the cancer or its treatment that can mimic or look very much like depression and anxiety, the challenges for diagnosis and treatment are great. How do we increase awareness about the importance of recognizing depression and anxiety? How do we determine best ways to screen for distress and then provide treatments for these symptoms when they occur? How do we provide interventions for various types and stages of cancers, patients of different genders, ages, cultural backgrounds, past psychiatric histories?

This presentation will provide ways to address these very important and critical issues in psychooncologic care. We will include one patient, one spouse and one sibling in the panel to receive their point of view and insights how our care can be improved, how communication can be enhanced and how we all can strive to improve the quality of care.

Prof. Michelle Riba, MD, MS

Prof. Riba studied chemistry in Queens College, (NY, USA), organic chemistry in St. John’s University (NY, USA), and medicine in University of Connecticut School of Medicine (USA) to earn M.D. in 1985 and psychiatry residence in 1989.

Currently is a Professor and Associate Chair for Integrated Medicine and Psychiatric Services and Associate Director of the University of Michigan Comprehensive Depression Center, Director of the Psychoncology Program at the University of Michigan Comprehensive Cancer Center and Director of the Psychosomatic Fellowship Program.

Prof. Riba is Past President of the American Psychiatric Association (APA), the Association for Academic Psychiatry and American Association of Directors of Psychiatric Residency Training. She has served as the representative to the World Psychiatric Association (WPA) from the APA and is currently WPA Secretary for Scientific Publications.

Prof. Riba is the author or editor of over 100 scientific articles, books, chapters, scientific abstracts and has served on the editorial board of Psychiatric Services and Cancer News on the Net, Current Psychiatry and has served on the editorial advisory board of the American Psychiatric Press, Inc. She is a reviewer for Psycho-Oncology; Academic Psychiatry; Psychiatric Services; Journal of Psychiatric Practice; and Psychosomatic Medicine; Breast Cancer Research and Treatment. As a psychosomatic medicine psychiatrist, Dr. Riba’s clinical and research interests include collaborative care, psychoncology, depression and cardiovascular disease, and screening for distress in patients with medical illness.

Title: Patient-centered communication and shared decision making in cancer care

There is growing recognition throughout the medical and scientific research community that an interdisciplinary approach to cancer treatment and care should incorporate patient-centered communication to maximize the benefit of current medical practices and treatment. Communication between physicians and patients is a

multidimensional concept and involves several key components including both verbal and non-verbal communication.

The goals of effective communication include establishing trust and rapport between the physician and patient, information gathering about the patient, and effectively providing information about the illness and treatment. Additionally, eliciting patient’s concerns and addressing these concerns is essential. Effective and supportive communication can assist the patient and his or her family in navigating their way through the complicated course of cancer treatment from informed consent, access to health care information and compassionate care, and when warranted, a successful transition to palliative care.

Topics to be addressed include:

• What is the responsibility of the physician in charge regarding engaging the family?
• Ways to best engage the patient and the family in discussion and decision making?

Κristin Baird, MD

Dr. Kristin Baird is a pediatric hematologist-oncologist in Bethesda, Maryland. She received her medical degree from Temple University School of Medicine and completed Residency Training in Pediatrics at the University of California Los Angeles Medical Center in June 2000. She is a graduate of the Johns Hopkins University / National Cancer Institute Pediatric Hematology/Oncology/Fellowship Training Program.

Dr. Baird's research interests focused on the genetics and biology of pediatric sarcomas in the lab of Dr. Paul Meltzer. She had a clinical research interest in hematopoietic stem cell transplantation and chronic graft-versus-host disease. She served as the Pediatric Chair of the Natural History Study of Clinical and Biological Factors in Patients with Chronic Graft-Versus-Host Disease After Prior Allogeneic Hematopoietic Stem Cell Transplantation.

Title: Psychosocial Therapeutic Interventions throughout the Adolescent and Young Adult (AYA) Cancer Trajectory

Adolescents and young adults engage in a myriad of development tasks. These tasks are disrupted when a diagnosis of cancer is made. Psychosocial stressors will be reviewed and assessment domains for psychosocial adjustment described. Ways to improve coping and adaptation will be provided, including educational, family and peer interventions. Tools to support AYAs during cancer treatment, survivorship and when cure is not possible will be presented.

Lori Wiener, PhD

Lori Wiener, PhD, is head of the Psychosocial Support and Research Program at the National Institutes of Health (NIH). As both a clinician and behavioral scientist, Dr. Wiener has dedicated her career to the fields of oncology and pediatric HIV/AIDS. Dr. Wiener provides counseling to the children, family members, siblings, donors, adolescents and young adults who are affected by NIH clinical trials and conducts research aimed at improving the cancer experience. For 30 years, Wiener has worked at the Pediatric Oncology Branch at NCI’s Center for Cancer Research, where she is a principal investigator and also provides therapeutic interventions to pediatric oncology patients and their families on ways to cope and adapt to their diagnosis and treatment.

Dr. Wiener focuses on quality of life for patients receiving treatment at the clinical center at the National Cancer Institute, where she carries out studies that look at how kids cope, with the goal of developing new materials, new resources and new interventions. She speaks with families whose children have been diagnosed with life-threatening conditions and are faced with the overwhelming challenges looking for treatment, coping with a big degree of uncertainty about available and appropriate treatments for their children, managing undergoing treatments and participating in protocols for their cancer, while also having to manage the high expense of these treatments. Dr. Wiener leads research for developing guidelines, solution-focused tools and strategies to help patients and families maintain the best mental and emotional strength to cope and manage the totality of their treatment and care under these challenging conditions.

Title: Management of sleep disturbance and other neuropsychiatric issues in oncology patients.

Cancer is frequently accompanied by various neuropsychiatric problems, which may either be direct results of the illness itself, or may result from the effect of medication on neural cells. These problems might either be neurological such as disorders of vision, hearing, balance, muscle strength, or psychiatric such as anxiety, depression or sleep disorders. While the latter may also result from neural damage, they are usually a consequence of psychological parameters associated with diagnosis, or with quality of life deterioration due to the disease and its treatment. This presentation addresses the need to recognize these neuropsychiatric problems and their causes, as well as the importance of their management, with a focus on sleep disorders.

Prof. Δημήτρης Δικαίος, MD, PhD

Dimitris Dikeos, MD, is Professor of Psychiatry at the 1st Department of Psychiatry of Athens University Medical School, Athens, Greece and Director of the Sleep Research Unit of Athens University at Eginition Hospital.

He is currently: President of the Hellenic Sleep Research Society (HSRS); Immediate Past President of the International Neuropsychiatric Association (INA); Member of the Executive Committee (Treasurer) of the World Federation of Societies for Biological Psychiatry (WFSBP).

His research activities are focused on sleep medicine, psychiatric genetics, psychopathology and psychopharmacology. He has participated in various Multicentre Research Programmes in Europe and the U.S.A. such as: European Collaborative Studies of Affective Disorders, Johns Hopkins Genetic Epidemiology Schizophrenia Program, Meta-analysis of Sleep Laboratory Studies on Tolerance and Rebound Insomnia with Rapidly Eliminated Hypnotics, Maudsley Family Study, European Collaborative study by the Group for the Study of Treatment Resistant Depression (TRD), International Multicentre Study “FACTOR”, International Study on the Genetics of Anorexia Nervosa, The Psychiatric Genetics Consortium (PGC), Neurobiology and Treatment of Adolescent Female Conduct Disorder: the Central Role of Emotion Processing (FemNAT-CD), etc.

He is or has been member of various scientific and professional Societies and Boards, as well as member of the Executive Committees of the Hellenic Sleep Research Society, the International Neuropsychiatric Association, the Athens Medical Society, the Hellenic Society for the Advancement of Psychiatry and Related Sciences, the World Federation of Societies for Biological Psychiatry, and the Committee of the Section on Psychiatry and Sleep-Wakefulness Disorders of the World Psychiatric Association (WPA). He has also served as member of the Editorial Board of the “Archives of Hellenic Medicine”, he was the Assistant Editor of the “American Journal of Psychiatry – Greece Edition” and he is a reviewer in many international Journals.

Dr. Dikeos is co-editor of three English-language books, two of which have been published by the World Psychiatric Association, and he is author or co-author of more than 100 full publications, out of which more than 60 are articles in SCI Journals (5474 citations on Google Scholar, h-factor=30), among which: American Journal of Medical Genetics, British Journal of Psychiatry, Current Opinion in Psychiatry, International Clinical Psychopharmacology, Journal of Psychosomatic Research, Molecular Psychiatry, Nature Genetics, Psychiatric Genetics, and Science.

Title: Particularities in young adult cancer patients

Though young adulthood is considered the healthiest time of life, many adolescents and late teens (15 - 24 years old) are diagnosed with certain types of cancer, such as Hodgkin lymphoma, melanoma, testicular cancer, thyroid cancer and sarcomas. Discussing the diagnosis of a cancer with young people with the added presence of the parents is challenging for all involved and unique age-appropriate communication processes are needed. Young adults (YA) are neither children nor adults. Though they are starting to take on responsibilities of adulthood, they are still emotionally and financially dependent from their parents and they have very specific concerns like forming intimate relationships, finishing school, beginning a career or starting families.

A cancer diagnosis abruptly delays or derails the development and achievement of these important social processes and life plans. When communicating with young people about the diagnosis of cancer and cancer treatment, health professionals need to respond to each patient’s level of maturity and independence. Good communication between patients, families, and doctors is very important in cancer care and improves the patient's well-being and quality of life. Psychosocial support services for YA’s are limited.

Alexandros Spyridonidis

Alexandros Spyridonidis is Professor of Haematology and Director of the Bone Marrow Transplantation Unit in University of Patras in Greece. After completing his medical studies in Aristotle University of Thessaloniki in Greece, he pursued postgraduate doctoral studies and completed his specialization in internal medicine and in haematology/oncology in the Dept. of Haematology/Oncology of University of Freiburg in Germany where he has been given the Venia Legendi (Assistant Professorship). In 2006, he was appointed at the University of Patras in Greece where he established from the scratch a fully accredited allogeneic bone marrow transplant program and an internationally recognized donor registry (CBMDP-“Save a Life”). He spent a research sabbatical in 2012 at the “National Institute of Health” in Washington D.C. working on the clinical establishment of multi-virus specific T-cells. On the national level, he is President of the BMT WP of the Hellenic Society of Haematology (HSH), founding member of the “Hellenic Society of Gene Therapy and Regenerative Medicine” and served as board member of the HSH and of various organizations dealing with stem cell donation. In International level, he is Hellenic Representative in European Union Commission for “Tissues and Cells”, board member of the “Centre of the Study of Haematological Malignancies” in Cyprus, Mentor of the “European Haematology Association” and inspector in the quality assessment agencies for BMT units in Europe. He has over 2 Million Euros in competitive research grants. He has more than 70 peer-reviewed original publications and more than 23 book chapters in international books. He has received 15 national and 11 international prizes.

Communication and Management of Cancer in Young Adults and Their Families

Young-adult oncology patients as a group have special needs, because in many ways they are still children who are treated by the health system as adults and have to be treated in adult hospitals.

Unlike children, young-adults understand exactly what is going on, and typically have more extreme reactions to their diagnosis, treatment and prognosis, e.g. greater anger, conflicts, and depression. In other words, they face intense psychosocial challenges. At the same time, their families play a significant role in the whole trajectory of the disease and treatment. This is why it is essential to have a psychologist involved in the medical team treating young-adults and their families. /p>

In addition, it is also important to provide psychological support and guidance for physicians and nurses caring for young-adults. Frequently, doctors experience an emotional charge when caring for young adults which, especially in cases where there is no cure, leaves them at a loss for how to communicate with these patient, lead them to hide behind their medical teams. This strong emotional charge on doctors of young-adult patients, combined with continuing pressure from patients’ families, is further complicated by the evolving psychological maturity of young adults, making the guidance and support of these doctors a necessity.

We will explore the issues and challenges that arise throughout the trajectory of the illness between the medical team and patients, as well as with their families. We will then discuss communication strategies that are supported by research, the experience in other countries and their relevance and applicability in Greece, as well as the conditions and contributing factors for their successful application. Our goal is to put forth promising ideas for how to improve and facilitate communication with young-adult oncology patients and their families, in order to help them be appropriately informed, reduce stress, and contribute to better quality of life and health outcomes.

Strategies and tools for holding courageous conversations with cancer patients and families

Including adolescents and young adults (AYA) in difficult conversations and advance care planning has been identified by the Institute of Medicine as a standard designed to promote patient-centered care. Unfortunately, adolescents do not always participate in these discussions. This exclusion often occurs because providers are uncomfortable and unprepared to initiate these important discussions, AYA may want to protect their parents, and parents are often hesitant to talk about death with their child. We know from our research, and that of other scientists, that adolescents want to engage in these conversations and they can participate. Also, parents report less decisional regret and psychosocial long-term outcomes when their child participated in advanced care planning decisions.

In this workshop we will introduce three tools designed to engage adolescent patients in the discussion.

1. ShopTalk: a therapeutic game, created to help youth living with cancer talk about their illness in a non-threatening way with a health care provider.
2. Jenga: a game that uses stacked wood blocks inscribed with thought provoking questions that encourage discussion.
3. My Gift of Grace (now called Hello): a conversation card game. 74% of people who played My Gift of Grace went on to perform an advance care planning activity following the game.
4. Voicing My Choices: an advance care planning guide developed following extensive research with adolescents and young adults.

We will first introduce each of the tools, then invite participants to practice in a small group, rotating through the different tools. After the small groups practice each tool, we will report our experiences to the large group as a whole.

Cancer and Distress-Improving Communication

A new cancer diagnosis or recurrence can result in various levels of depression or anxiety for adult, adolescent and child cancer patients, and their families. The distress can arise from a multitude of factors: from the diagnosis itself; potential or perceived disruptions to quality of life including family, work, school, finances, and relationships; responses from the social support system, including miscommunications, too little or too much information; direct or side effects from treatments, either primary or adjuvant; direct or indirect result of the cancer itself; current or past psychiatric history; etc. Since patients also often have cancer related pain, fatigue, and symptoms from the cancer or its treatment that can mimic or look very much like depression and anxiety, the challenges for diagnosis and treatment are great. How do we increase awareness about the importance of recognizing depression and anxiety? How do we determine best ways to screen for distress and then provide treatments for these symptoms when they occur? How do we provide interventions for various types and stages of cancers, patients of different genders, ages, cultural backgrounds, past psychiatric histories? This presentation will provide ways to address these very important and critical issues in psycho-oncologic care. We will include patients and families in the workshop to receive their point of view and insights how our care can be improved, how communication can be enhanced and how we all can strive to improve the quality of care.