OEMAC Psychological aspects in a return to work after a diagnosis of cancer Marika Audet-Lapointe, Ph.D Psychologist in oncology [email protected] www.psymedicis.com Conflicts of interest Speaker is or has acted as expert consultant and speaker for: Hoffmann-LaRoche Sanofi - Aventis Celgene Inc. Learning objectives Identify psychological issues surrounding return to work in an oncology setting Identify the psychological consequences of cancer treatments/cognitive function, emotional regulation Incorporate ways to optimize professional skills 1 Onco-psychology Psychological health Cancer Cancer Psychological health Psychological stress? « Stress is NUTS » Novelty Unpredictability Threat to the Ego Sense of Control Cognitive interpretation http://www.humanstress.ca/ Cancer and NUTS N : novelty (disease, treatment, hospital, medical language) U: unpredictable therapeutic success, unclear etiology T: life / death, identity, sexuality, body image S: loss of body control (sens of control) 2 Work and cancer Coping Avoidance Assess!!! Return to work, why? Recovery, restoring identity Sens of normality Sens of control Distraction Financial need Support/social network McKay et al. 2013; Van Muijen et al., 2013; Wells et al. 2012 Return to work - challenges Work aspect Emotional Cognitive 3 Work aspect employee apprehension/expectation manager expectation manager cancer knowledge cancer belief in team work McKay et al. 2013; Van Muijen et al., 2013; Wells et al. 2012 Emotinal challenges Fear of recurrence Identity (disorientation) Stress reactiviy Beliefs around work stress and cancer Fatigabillity Why emotional vulnerability? Adaptation process Psychological factor Stress response (cortisol) Iatrogenic menopause Dehydration, anemia, thyroid function 4 Cognitive challenges Chemobrain/ chemofog/ Chemotherapyinduced cognitive impairment (CICI), Cerveau dans le brouillard/ brouillard cérébral Chemobrain Régulation adaptation Argyriou et al. (2010) Structural and functional neuroimaging Simo et al. 2013 5 Agents chimiothérapeutiques 5-fluorouracil (5FU) FAC (5-FU/adriamycine/cyclophosphamide) FEC (5-fluorouracil/epirubicin/ cyclophosphamide) CMF (cyclophosphamide/methotrexate/5-FU) Taxane (paclitaxel, docétaxel ) Cisplantin, carboplatin Vincristine Traitement hormonal tamoxifen, anastrazole Noggle & Dean, 2013; O’Farrell et al., 2013, Joly et al. 2011 Chimiothérapie Hormonothérapie Radiothérapie Vulnérabilité génétique APOE-E4 Altération myéline/ oligodendrocyte Stress (cortisol) Réduction œstrogènes et testostérone Chemobrain (difficultés cognitives) Lésions ADN et raccourcissement des télomères Trouble dépressif/ anxieux fatigue Dysrégulation des cytokines Noggle & Dean, 2013; Ahles Joly et al. 2011; Argyriou et al., 2010 Return to work : be aware of? worthlessness persistant fatigue cognitive complaint persistent sadness, anxiety, anger, fear, demotivation teamwork related complaint 6 Maybe is Chemobrain Ineffective stress regulation Psychological challenge Psychological assessment Neuropsychological assessment Key of success information, information and information a planned return manager/employee communication 7