Kanser Hastalarında Bilişsel Davranışçı Terapi

Bilişsel Davranışçı Terapi kanser hastalarında uygulanan yapılandırılmış ama esnek psikososyal müdahalelerden biridir. Bilişsel davranışçı terapinin psikolojik morbiditeyi azaltmada olumlu etkilerinin olduğu ve kanserli hastaların yaşam kalitesini artırdığı yapılan birçok çalışmada belirtilmiştir. Bu makalede kanser hastaları için uyarlanmış bilişsel davranışçı terapi'nin içeriği, teknikleri ve kanser hastalarında görülen yaygın psikiyatrik bozukluklarda etkinliği gözden geçirilmiştir. Makalenin, ülkemizde özellikle hekim ve hemşireler tarafından psikolojik sıkıntıların erken tanınmasını ve hastaların ilgili terapistlere yönlendirilmesine bu sayede kanserli hastaların yaşam kalitesinin yükselmesine ve kendilerini daha iyi hissetmelerine olumlu katkıda bulunması amaçlanmıştır.

Cognitive Behavioral Therapy in Cancer Patients

Cognitive behavioral therapy is one of the structured but flexible psychosocial interventions that could be applied to patients with cancer. In many studies the positive effects of cognitive behavioral therapy in reducing psychological morbidity and improving the quality of life of cancer patients have been shown. In this article, the contents and techniques of adapted cognitive behavioral therapy for patients with cancer and its effectiveness in commonly seen psychiatric disorders have been reviewed. The aim of this article is to contribute positively to physicians and nurses in Turkey for early detection of psychological distress and referral to the therapist that would clearly increase the quality of life of cancer patients.

___

  • Boyle P, Levin B. Dünya Kanser Raporu. Lyon, Uluslararası Kanser Araştırmaları Kurumu, 2008.
  • Türkiye İstatistik Kurumu. Türkiye İstatistik Yıllığı 2009. http://www.kanser.gov.tr/daire-faaliyetleri/kanserkayitciligi/108-t%C3%BCrkiyede-kanser-kayitcigi.html (2 Aralık 2013'te ulaşıldı).
  • T.C Sağlık Bakanlığı. Türkiye'de kanser kontrolü. http://onkofar.com/vImages/pdfler/ 2009_Turkiyedekanserkontrolu.pdf (2 Aralık 2013'te ulaşıldı).
  • Ridner SH. Psychological distress: concept analysis. J Adv Nurs 2004; 45:536–545.
  • Bidstrup PE, Johansen C, Mitchell AJ. Screening for cancer-related distress: summary of evidence from tools to programmes. Acta Oncol 2011; 50:194–204.
  • Raison CL, Miller AH. Depression in cancer: new developments regarding diagnosis and treatment. Biol Psychiatry 2003; 54:283–294.
  • Uyer M, Uslu R, Yıldırım-Kuzeyli Y. Kanser ve Palyatif Bakım. İzmir, Meta Basım Matbaacılık Hizmetleri, 2006.
  • Blank TO, Kwan L, Ganz PA, Stanton AL, Park CL, Yanez B et al. Facets of spirituality as predictors of adjustment to cancer: relative contributions of having faith and finding meaning. J Consult Clin Psychol 2009; 77:730-741.
  • Ciaramella A, Spiegel D. Psychiatric disorders among cancer patients. Handb Clin Neurol 2012; 106:557–572.
  • Uitterhoeve RJ, Vernooy M, Litjens M, Potting K, Bensing J, De Mulder P et al. Psychosocial interventions for patients with advanced cancer - a systematic review of the literature. Br J Cancer 2004; 91:1050–1062.
  • Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev 2009; (1):CD006953.
  • Jacobsen PB, Jim HS. Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges. Ca Cancer J Clin 2008; 58:214–230.
  • Carlson LE, Bultz BD. Efficacy and medical cost offset of psychosocial interventions in cancer care: making the case for economic analyses. Psychooncology 2004; 13:837–849.
  • Fors EA, Bertheussen GF, Thune I, Juvet LK, Elvsaas I-KØ, Oldervoll L et al. Psychosocial interventions as part of breast cancer rehabilitation programs? results from a systematic review. Psychooncology 2011; 20:909–918.
  • Zimmermann T, Heinrichs N, Baucom DH. “Does one size fit all?” moderators in psychosocial interventions for breast cancer patients: a meta-analysis. Ann Behav Med 2007; 34:225–239.
  • Gielissen MFM, Verhagen CAHHVM, Bleijenberg G. Cognitive behaviour therapy for fatigued cancer survivors: long-term follow-up. Br J Cancer 2007; 97:612–618.
  • Mannix KA, Blackburn IM, Garland A, Gracie J, Moorey S, Reid B et al. Effectiveness of brief training in cognitive behaviour therapy techniques for palliative care practitioners. Palliat Med 2006; 20:579–584.
  • Semple CJ, Dunwoody L, Sullivan K, Kernohan WG. Patients with head and neck cancer prefer individualized cognitive behavioural therapy. Eur J Cancer Care 2006; 15:220–227.
  • Güleç G, Büyükkınacı A. Kanser ve psikiyatrik bozukluklar. Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 2011; 3:343-367.
  • Karakoyun-Celik O, Gorken I, Sahin S, Orcin E, Alanyali H, Kinay M. Depression and anxiety levels in woman under followup for breast cancer: relationship to coping with cancer and quality of life. Med Oncol 2010; 27:108–113.
  • Tokgöz G, Yaluğ İ, Özdemir S, Yazici A, Uygun K, Aker T. Kanser hastalarında majör depresyon yaygınlığı ve ilişkili etkenler. Anadolu Psikiyatri Dergisi 2008; 9:59–66.
  • Sertöz ÖÖ. Kanserde psikoterapi uygulamaları. Turkiye Klinikleri Tıbbi Onkoloji Özel Dergisi 2012; 5:27-32.
  • Meyer F, Ehrlich M, Peteet J. Psycho-Oncology: a review for the general psychiatrist. Focus 2009; 7:317–331.
  • Derogatis LR, Morrow GR, Petting J, Penman D, Piasetsky S, Schmale AM et al. The prevalence of psychiatric disorders among cancer patients. JAMA 1983; 249:751-757.
  • Moorey S, Greer S. Psychological Therapy for Patients with Cancer. Oxford, Heinemann Medical Books, 1989.
  • Moorey S, Greer S. Cognitive Behavior Therapy for People with Cancer. New York, Oxford University Press, 2002.
  • Moyer A, Sohl SJ, Knapp-Oliver SK, Schneider S. Characteristics and methodological quality of 25 years of research investigating psychosocial interventions for cancer patients. Cancer Treat Rev 2009; 35:475–484.
  • Hopko DR, Bell JL, Armento M, Robertson S, Mullane C, Wolf N et al. Cognitive-behavior therapy for depressed cancer patients in a medical care setting. Behav Ther 2008; 39:126–136.
  • Greer JA, Park ER, Prigerson HG, Safren SA. Tailoring cognitive-behavioral therapy to treat anxiety comorbid with advanced cancer. J Cogn Psychother 2010; 24:294–313.
  • Boutin DL. Effectiveness of cognitive behavioral and supportive-expressive group therapy for women diagnosed with breast cancer: a review of the literature. J Spec Gr Work 2007; 32:267–284.
  • Watson M, Kissane D. Handbook of Psychotherapy in Cancer Care. Oxford, Wiley, 2011.
  • Lee H, Lim Y, Yoo MS, Kim Y. Effects of a nurse-led cognitive-behavior therapy on fatigue and quality of life of patients with breast cancer undergoing radiotherapy: an exploratory study. Cancer Nurs 2011; 34:22–30.
  • Cohen M, Kuten A. Cognitive-behavior group intervention for relatives of cancer patients: a controlled study. J Psychosom Res 2006; 61:187–196.
  • Folkman S, Greer S. Promoting psychological well-being in the face of serious illness: when theory, research and practice inform each other. Psychooncology 2000; 9:11–19.
  • Edelman S, Lemon J, Kidman A. Group cognitive behavior therapy for breast cancer patients: a qualitative evaluation. Psychol Health Med 2005; 10:139–144.
  • Lovejoy NC, Matteis M. Cognitive-behavioral interventions to manage depression in patients with cancer: research and theoretical initiatives. Cancer Nurs 1997; 20:155–167.
  • Anderson T, Watson M, Davidson R. The use of cognitive behavioural therapy techniques for anxiety and depression in hospice patients: a feasibility study. Palliat Med 2008; 22:814–821.
  • Tatrow K, Montgomery GH. Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med 2006; 29:17–27.
  • Spiegel D, Marrow G, Classen C, Raubertas R, Stott PB, Mudalıar N et al. Group psychotherapy for recently diagnosed breast cancer patients: a multicenter feasibility study Psychooncology 1999; 8:482–493.
  • Spiegel D. Psychosocial support for patients with cancer. Cancer 1994; 74:1453-1457
  • Mann E, Smith MJ, Hellier J, Balabanovic JA, Hamed H, Grunfeld EA et al. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial. Lancet Oncol 2012; 13:309–318.
  • Edelman S, Kidman AD. Description of a group cognitive behaviour therapy programme with cancer patients. Psychooncology 1999; 8:306–314.
  • Edelman S, Bell DR, Kidman AD. A group-cognitive behaviour therapy programme with metastatic breast cancer patients. Psychooncology 1999; 8:295–305.
  • Compas BE, Haaga DAF, Keefe FJ, Leitenberg H, Williams DA. Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa. J Consult Clin Psychol 1998; 66:89–112. Yavuzsen T, Karadibak D, Cehreli R, Dirioz M. Effect of group on psychological symptoms and quality of life in Turkish patients with breast cancer. Asian Pacific J Cancer Prev 2012; 13:5593-5597.
  • DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: metaanalysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160:2101–2107.
  • Nordin K, Berglund G, Glimelius B, Sjödén PO. Predicting anxiety and depression among cancer patients: a clinical model. Eur J Cancer 2001; 37:376–384.
  • Van’t Spijker A, Trijsburg RW, Duivenvoorden HJ. Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med 1997; 59:280–293.
  • Ashbury FD, Madlensky L, Raich P, Thompson M, Whitney G, Hotz K et al. Antidepressant prescribing in community cancer care. Support Care Cancer 2003; 11:278–285.
  • Delgado-Guay M, Parsons HA, Li Z, Palmer JL, Bruera E. Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Support Care Cancer 2009; 17:573–579.
  • Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a metaanalysis. Cancer 2009; 115:5349–5361.
  • Stommel M, Given BA, Given CW. Depression and functional status as predictors of death among cancer patients. Cancer 2002; 94:2719–2727.
  • Ng GC, Boks MPM, Zainal NZ, Wit NJ. The prevalence and pharmacotherapy of depression in cancer patients. J Affect Disord 2011; 131:1-7.
  • Stiefel F, Trill M, Berney A, Olarte J, Razavi D. Depression in palliative care: a pragmatic report from the expert working group of the european association for palliative care. Support Care Cancer 2001; 9:477–488.
  • Williams S, Dale J. The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Br J Cancer 2006; 94:372–390.
  • Price A, Hotopf M. The treatment of depression in patients with advanced cancer undergoing palliative care. Curr Opin Support Palliat Care 2009; 3:61–66.
  • Schneider S, Moyer A, Knapp-Oliver S, Sohl S, Cannella D, Targhetta V. Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis. J Behav Med 2010; 33:1–14.
  • Miovic M, Block S. Psychiatric disorder in advanced cancer. Cancer 2007; 110:1665-1676.
  • Trill MD. Anxiety and sleep disorders in cancer patients. Eur J Cancer 2013; 11(suppl 2):216–224.
  • Paice JA: Managing psychological conditions in palliative care: dying need not mean enduring uncontrollable anxiety, depression, or delirium. Am J Nurs 2002; 102:36-42.
  • Wasan AD, Artamonov M, Nedeljkovic SS. Delirium, depression, and anxiety in the treatment of cancer pain. Tech Reg Anesth Pain Manag 2005; 9:139–144.
  • Mundy EA, DuHamel KN, Montgomery GH. The efficacy of behavioural interventions for cancer treatment-related side effects. Semin Clin Neuropsychiatry 2003: 8;253–275.
  • American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision (DSM IV-TR). Washington, DC, American Psychiatric Association, 2000.
  • Ateşçi FÇ, Oğuzhanoğlu NK, Baltalarlı B, Karadağ F, Özdel O, Karagöz N. Kanser hastalarında psikiyatrik bozukluklar ve ilişkili etmenler. Turk Psikiyatri Derg 2003; 14:145-152.
  • Akechi T, Okamura H, Nishiwaki Y, Uchitomi Y. Predictive factors for suicidal ideation in patients with unresectable lung carcinoma. Cancer 2002; 95:1085–1093.
  • Prieto JM, Blanch J, Atala J, Carreras E, Rovira M, Cirera E et al. Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation. J Clin Oncol 2002; 20:1907-1917.
  • Redd WH, Montgomery GH, DuHamel KN. Behavioral intervention for cancer treatment side effects. J Natl Cancer Inst 2001; 93:810–823.
  • Trijsburg R, Knippenberg FCE, Rijpma SE. Effect of psychological treatment on cancer patients: a critical review. Psychosom Med 1992; 54:489–517.
  • Sateia MJ, Lang BJ. Sleep and cancer: recent developments. Curr Oncol Rep 2008; 10:309–318.
  • Graci G. Pathogenesis and management of cancer-related insomnia. J Support Oncol 2005; 3:349–359.
  • Davidson JR, MacLean AW, Brundage MD, Schulze K. Sleep disturbance in cancer patients. Soc Sci Med 2002; 54:1309– 13
  • Fleming L, Gillespie S, Espie CA. The development and impact of insomnia on cancer survivors: a qualitative analysis. Psychooncology 2010; 19:991–996.
  • Babson KA, Feldner MT, Badour CL. Cognitive behavioral therapy for sleep disorders. Psychiatr Clin North Am 2010; 33:629–640.
  • Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep 2006; 29:1398-1414.
  • Woodward CS. Cognitive-behavioral therapy for insomnia in patients with cancer. Clin J Oncol Nurs 2011; 15:42-52.
  • Harvey AG, Tang NK, Browning L. Cognitive approaches to insomnia. Clin Psychol Rev 2005; 25:593-611.
  • Espie CA, Fleming L, Cassidy J, Samuel L, Taylor LM, White CA et al. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol 2008; 26:4651–4658.
  • O'Donnell J. Insomnia in cancer patients. Clin Cornerstone 2004; 6(suppl 1D):6-14.
  • Quesnel C, Savard J, Simard S, Ivers H, Morin, CM. Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. J Consult Clin Psychol 2003; 71:189–200.
  • Savard J, Simard S, Ivers H, Morin CM. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: sleep and psychological effects. J Clin Oncol 2005; 23:6083–6096.
  • Aslan S. Uykusuzluk psikoterapisi: bilişsel davranışçı psikoterapi. Turkiye Klinikleri Psikiyatri Özel Dergisi 2013; 6:60-68. Anderson KO, Getto CJ, Mendoza TR, Palmer SN, Wang XS, Reyes-Gibby CC et al. Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults. J Pain Symptom Manage 2003; 25:307– 3
  • Parker PA, Baile WF, Moor CD, Cohen L. Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psychooncology 2003; 12:183-193.