Psychological aspects in a return to work after a diagnosis

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