Geriatric psycho-oncology : a quick reference on the psychosocial dimensions of cancer symptom management

225 Pages·2015·4.28 MB·English

by  Alici

Geriatric
Psycho-Oncology
APOS CLINICAL REFERENCE HANDBOOKS
Psycho-Oncology: A Quick Reference on the Psychosocial Dimensions of Cancer
Symptom Management, 2nd edition, Jimmie C. Holland, Mitch Golant,
Donna B. Greenberg, Mary K. Hughes, Jon A. Levenson, Matthew J. Loscalzo,
William F. Pirl
Pediatric Psycho-Oncology: A Quick Reference on the Psychosocial Dimensions
of Cancer Symptom Management, 2nd edition, Lori S. Wiener, Maryland Pao,
Anne E. Kazak, Mary Jo Kupst, Andrea Farkas Patenaude
Geriatric Psycho-Oncology: A Quick Reference on the Psychosocial Dimensions
of Cancer Symptom Management, Jimmie C. Holland, Talia Weiss Wiesel,
Christian J. Nelson, Andrew J. Roth, Yesne Alici
Geriatric
Psycho-Oncology
A Quick Reference on the Psychosocial
Dimensions of Cancer
Symptom Management
Edited by
Jimmie C. Holland, MD
Talia Weiss Wiesel, PhD
Christian J. Nelson, PhD
Andrew J. Roth, MD
Yesne Alici, MD

1
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Library of Congress Cataloging-in-Publication Data
Geriatric psycho-oncology : a quick reference on the psychosocial dimensions of
cancer symptom management / edited by Jimmie C. Holland, Talia Weiss Wiesel,
Christian J. Nelson, Andrew J. Roth, Yesne Alici ; with the American
Psycho-Social Oncology Society.
p. ; cm.
Includes bibliographical references and index.
ISBN 978–0–9–93646–5 (alk. paper)
I. Holland, Jimmie C., editor. II. Wiesel, Talia Weiss, editor. III. Nelson, Christian J.,
editor. IV. Roth, Andrew J., editor. V. Alici, Yesne,
editor. VI. American Psychosocial Oncology Society.
[DNLM: . Aged—psychology. 2. Mental Disorders—psychology.
3. Neoplasms—psychology. 4. Patients—psychology. WT 45]
RC28.A34
68.97´6994009—dc23
204022638
This material is not intended to be, and should not be considered, a substitute for medical
or other professional advice. Treatment for the conditions described in this material is
highly dependent on the individual circumstances. And, while this material is designed to
offer accurate information with respect to the subject matter covered and to be current
as of the time it was written, research and knowledge about medical and health issues
is constantly evolving and dose schedules for medications are being revised continually,
with new side effects recognized and accounted for regularly. Readers must, therefore,
always check the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers and the
most recent codes of conduct and safety regulation. The publisher and the authors make
no representations or warranties to readers, express or implied, as to the accuracy or
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disclaim, any responsibility for any liability, loss, or risk that may be claimed or incurred as a
consequence of the use and/or application of any of the contents of this material.
9 8 7 6 5 4 3 2 
Printed in the United States of America
on acid-free paper
Contents
Foreword vii
Preface ix
Contributors xi
I. Screening and Interventions 
. Psychosocial Screening Instruments for Older
Cancer Patients 3
William F. Pirl, Stephanie Lacey, and Mark I. Weinberger
2. Functional Assessment for Older Adults with Cancer 9
Tanya M. Wildes
3. Psychosocial Interventions for Older Cancer Patients 27
Lea Baider, Talia Weiss Wiesel, and Jimmie C. Holland
v
II. Psychiatric Emergencies and Disorders 39
4. Psychiatric Emergencies 4
Andrew J. Roth
5. Cognitive Disorders and Delirium 5
Charissa Andreotti, James C. Root, Yesne Alici, and
Tim A. Ahles
6. Depressive Spectrum Disorders and Grief 59
Andrew J. Roth, Mindy Greenstein, Talia Weiss Wiesel,
and Steven Schulberg
7. Anxiety Disorders 69
Tatiana D. Starr, Talia Weiss Wiesel, and Yesne Alici
8. Substance-Use Disorders in Older Adults with
Chronic Cancer Pain 79
Adam Rzetelny, Matthew Ruehle, Nicholas Miller,
Kenneth L. Kirsh, and Steven D. Passik
9. Personality Disorders in Older Cancer Patients 87
Kenneth L. Kirsh, Steven D. Passik, and
Andrew J. Roth
TS III. Physical Symptom Management 95
N
TE 0. Fatigue 97
N
O Daisuke Fujisawa and William F. Pirl
C
. Pain 07
Roma Tickoo and Archana Bushan
2. Sexual Dysfunction 7
Mary K. Hughes, Stephanie Lacey, and Christian J. Nelson
IV. Special Considerations in Psychosocial Issues in
Older Patients with Cancer 23
3. Communicating with Older Cancer Patients 25
Elizabeth Harvey and Christian J. Nelson
4. Demoralization, Despair, and Existential Concerns 29
Talia Weiss Wiesel
5. Caregiver Burden 3
Barbara A. Given
6. Advance Directives 4
vi
Talia Weiss Wiesel and Yesne Alici
7. Psychosocial Issues in Elderly Minority Population 45
Talia Weiss Wiesel and Mark I. Weinberger
V. Issues Specific to Common Cancer Sites 5
8. Prostate Cancer 53
Andrew J. Roth and Mindy Greenstein
9. Psychosocial Issues Specific to Breast Cancer 6
Matthew N. Doolittle and Mary Jane Massie
20. Lung Cancer 69
R. Garrett Key
2. Colorectal Cancer 8
Kimberley Miller
22. Leukemia and Lymphoma 87
Tomer T. Levin
Appendix: National Resources 93
Index 99
Foreword
Geriatric oncology is a rapidly evolving field of medicine. The overall
increase in life expectancy results in rapidly changing demographics with
significant aging of the world population. As cancer incidence and cancer
mortality increase with age, the number of older adults with cancer will
represent a significant challenge in the future of public health.
Older adults have very special needs. As a geriatrician taking care of
patients in a comprehensive cancer center, I am constantly surprised by the
complexity of the medical care of patients who, in addition to their cancer
diagnosis, have an incredibly high prevalence of frailty, multiplicity of dis-
ease, disabilities, and decline in their functional reserve, cognitive impair-
ment, and progressive restriction in personal and social resources. The
distress associated with surgery, radiation, chemotherapy, pain, and other
symptoms related to cancer and cancer treatment is complicated by psy-
chiatric and psychological issues found more frequently in the aging patient,
such as undiagnosed mental illness, memory impairment and loneliness, vii
lack of social support, or caregiver stress.
Oncologists may not be aware of the geriatric-specific issues that need
to be addressed in addition to usual care. Are they communicating well
with the patient? Is the patient understanding the important nuances of the
treatment decisions? Are they obtaining consent correctly? Are the family
members interfering with or dictating patient’s wishes? Who will provide
advance directives?
This Handbook is written for oncologists, nurses, and other health
professionals who are treating older adults and are often unfamiliar with
the diagnosis and management of psychiatric comorbidities in cancer.
The authors address psychiatric disorders and psychosocial issues spe-
cific to symptoms and cancer sites. In addition, several chapters cover
unique problems of the elderly such as communication, social isolation,
and issues related to elderly care in minority groups. The final section
describes possible interventions and available resources for elderly can-
cer patients.
This Handbook stresses practical aspects of care and provides guidelines
for the clinicians as they strive to understand and manage the psychiatric
and psychological aspects of the disease. It will be invaluable in providing a
rapid and comprehensive source of information about criteria for diagnosis
and medications with dosages and precautions. Older patient’s care will be
enhanced by the fact that it will be easier for oncologists to deliver ”whole
patient” care that pays proper attention to the emotional as well as the
physical aspects. The Handbook authors are largely from Memorial Sloan
Kettering Cancer Center’s Geriatric Psychiatry and 65+ Hospital Program.
D However, there are valued contributors from several other centers. It is
R
O the hope that the Handbook will help oncologists in their care of elders
W
E with cancer in their practice.
R
O Beatriz Korc-Grodzicki, MD, PhD
F
Chief, Geriatrics Service
Department of Medicine
Memorial Sloan Kettering Cancer Center
New York, New York
viii
Preface
This book joins APOS Clinical Reference Handbooks Series developed to
provide a rapid pocket-sized “curbside consultation” for busy oncologic
physicians and their teams on the common psychiatric and psychological
problems confronted by children with cancer, adults—and now this edition
for older adults. The crisis in care of elders in our society is evolving rapidly
because of an unusual confluence of factors: the swell of the elder popula-
tion by the baby boomer generation’s reaching 65 and the fact that we are
living longer as elders with more comorbidities which require chronic medi-
cal care. These factors impact upon cancer care particularly, which is now
the leading cause of death, since heart disease is now better prevented and
treated and moves down to the second leading cause of death. Importantly
as well, is the fact that the medical care system has not produced the num-
ber of much needed and hoped for geriatricians with expertise to care for
this burgeoning population. Nor have we increased the numbers of geri-
atric psychiatrists to act as consultants to the physicians providing medical x
i
care to elders. Thus, this handbook fills a need to assure that physicians
caring for elders have ready access to information about the most com-
monly encountered problems: anxiety and how to treat it without sedation;
depression and deciding the cause and best treatment; recognizing poor
judgment and assessing for early cognitive problems; supporting elders in
the face of ageism in society, which is easily transmitted to medical teams
who become impatient with the slower and more difficult communication.
Fatigue, pain, and sexual dysfunction, often overlooked and neglected, are
discussed. This handbook also reviews the problems common to particular
sites of cancer in elders: breast, prostate, colon, lung, and lymphoma. What
are the safest pharmacologic interventions and precautions? What psycho-
social (nonpharmacologic) interventions have been tried and are effective
with elders? All are reviewed in chapters that deal with each.
The quality of medical care has improved in the last decade in part due
to the development of guidelines and checklists to assure full assessment.
This has been highly evident in oncologic care of elders who, for so long,
were excluded from cancer treatments based on age alone. A chapter by
Wildes deals with rapid clinical functional assessment that recognizes that
age alone is not a measure of appropriateness for chemotherapy or surgery
but, rather, how the person is functioning in all areas of physical, social, psy-
chological domains. Similarly, the use of scales to rapidly measure cognitive
function and the presence of depression or anxiety has proven to be helpful
to clinicians who are busy in clinics where time is a factor. The handbook