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PROSTATE CANCER.� SYMPTOMS Mx AND PSYCHOSOCIAL CARE.�� � Gladys N.Mukosi.�� Palliative Care Nurse Specialist-Knh.�����

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INTRODUCTION

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  • A diagnosis of prostate cancer can be a life-altering experience.

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  • It requires making difficult decisions about treatment that affects life of the patient and that of his family members.

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  • Prostate is a gland which produces prostatic fluid-that makes up part of the seminal fluid, semen.
  • The rest of semen is composed of sperm cells from the testicles, fluid from the seminal vesicles, and secretions from the pea-sized bulbourethral gland.
  • It sits underneath the bladder and surrounds the ureters.

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�Numerous health issues may affect the prostate as men get older;- ��prostatitis, prostate infections, enlarged prostate, and prostate cancer.��������

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���Prostate cancer may cause no signs or symptoms in its early stages.��In advanced stage it cause symptoms such as:��

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SIGNS

&

SYMPTOMS

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� Taking long to pass urine.�� Weak urinary flow.�� Bladder not emptying fully.�� Loss of bladder control.�� Sexual Disfunction or low libido.�

PROSTATE GLAND.

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DIAG

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��Painful micturition.��Hematuria.��Back pain.��

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SIGNS

&

SYMPTOMS

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Psychological

Distress

Associated

with

Prostate

Cancer

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  • The experience of having prostate cancer and going through treatment is a life stress.
  • Prostate cancer presents a threat to a patients future, his survival, and physical wellness.
  • Bodily integrity; social, family and intimate relationships.
  • Life style; financial and occupational security.

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Zaza C, Baine N. Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manage 2002;24:526–42

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� � Discomfort� Dependency. � Disfigurement of the body. � Disability - physical. � Disruption of lifestyle. � Disengagement. � Death.� Holland J: Psychological management of cancer patients and their families. � � Practical Psychology 1997.�

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The seven feared D’s of Cancer.

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HOLISTIC CANCER CARE APPROACH.

  • Cancer care often provides a state-of-the-science biomedical treatment.
  • But fails to address the psychosocial problems.
  • This compromises the effectiveness of treatment hence affecting the health of the patient. (Kornblith, 1998)

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  • The Distress Thermometer�This scale measures how distressed the patient feels on a scale of 0-10.� �The scale has been validated across cancer sites worldwide, in acute and community setting and more recently in prostate cancer populations.

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�Prostate cancer and its treatment cause significant anxiety which lead to sexual side effects that negatively impact personal identity, sexual function, and intimate relationships.��Hormone therapy affect libido and patients self-esteem. �80-91% of men have erectile dysfunction after hormone therapy in 1 yr,�

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�Radical prostatectomy.��Factors determining recovery of Erectile Disfunction after radical prostatectomy include: older age at time of the operations,  poor preoperative erections, lower grade nerve sparing, and having other medical problems associated with erectile dysfunction. 

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Erectile

Disfunction

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Existential suffering , spiritual pain and struggle occurs in 44% of patients on cancer treatment . ��Suicidal ideation is common.�Fear of cancer recurrence . �Partner abandonment or spousal desertion. �Divorce. �Infertility.

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Spiritual distress

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�A review of the psychological adjustment of female partners of men with prostate cancer concluded that partners report more distress than men themselves.

Distress

in Partners.��

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��A diagnosis of a life-threatening illness for a family member creates fear of losing a loved one and concern about the suffering he or she will endure. ��Family members’ psychological distress can be as severe as that of the patient.�

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Family involvement

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A meta-analysis of studies of psychological distress in both patients and their informal caregivers (predominantly spouses) found that the psychological distress of patients and their informal caregivers generally was parallel over time, although when the patient received treatment, caregivers experienced more distress than the patient (Hodges et al., 2005).�Thus, helping family members to manage their distress may have a beneficial effect on the distress of the patients. (Segrin et al., 2005, 2007).�

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Family involvement

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��Lack of social support has been associated with higher levels of anxiety and a lower quality of life. ��Patients who lack social support have a greater desire to die and a higher risk of committing suicide. ��To date information on how, or whether, psychosocial care has been recognized and integrated into comprehensive cancer care internationally has been limited. �

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Social support:

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�During doctor patient communication;��45% of patients concerns are not elicited.��50% of patients psychosocial problems are missed.

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Some

realities

Patients

care.

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Aggressive Pain and other symptoms management is key.��Pain is common and need to be managed using the WHO Pain Ladder. � �Include both pharmacologic and nonpharmacologic treatment.

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Physical

Symptoms

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The Doctor is the medicine.�� Clinical empathy = a clinical procedure.�� Empathy shifts arousal towards homeostasis:� Neurobiological intervention. � (Herbert Adler 2007)

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What does a patient want from a physician?�Trust, Competence and efficacy.��Treated with dignity and respect.��Need information on how the disease and treatment will affect;- family, friends, finances ,future.

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Healing Relationship.�You are practicing medicine when you are listening to patients.��The healer can reduce suffering even when cure is not possible.��Be there with and for the patient.

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CONCLUSION.

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  • The patient is not just a group of symptoms, damaged organs and altered emotions.

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  • The patient is a human being, at the same time worried and hopeful, who is searching for relieve, help and trust.

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