The column in this issue focuses on treatments of cancer.

Normal Pap Smear Result Requires Explanation

An investigation by Dr. Theresa M. Marteau of King's College in London showed that when informed only that their pap smear result was normal, only about 52% of subjects understood that there may still be a risk for cervical cancer.  By elaborating on this point, and adding an additional sentence of explanation, (that it does not guarantee that the patient will remain disease free over the next 5 year period and continued check ups are needed) 70% then understood what a "normal" pap smear result meant in regard to their health over the next 5 year period.
 

British Medical Journal- BMJ 2001; 322: 526-528.

--------------------------------------------------------------

Commandments for Working With Terminally Ill Patients

Dr. James Whitten lists Ten Commandments for caring for terminally ill patients.
I. Be a Straight Shooter-tell the truth to the patient and his/her family.
II. Be Empathetic-demonstrate understanding and that you're "tune in."
III. Ask About Consultations-be they psychiatric or sub-specialty second opinions.
IV. Do Not Abandon The Patient - don't "sign off."
V. Maintain a Regular Routine of Hospital Calls-reassuring to the patient.
VI. Obtain Support From One's Own Colleagues & Own Family-Preventing burn-out.
VII. Communicate with the Patient's Family-great source of information and help.
VIII. Preserve the Humanness of the Patient-Maintain Quality of Life.
IX. Be Concerned About Where the Patient Dies-Home Hospice or Hospital.
X. Preserve Hope.

American Family Physician, March 1, 1998

--------------------------------------------------------------
 

Balancing Control: Coping Styles for Patients with Breast Cancer

John Astin describes four distinctive modes or ways of gaining a sense of control for breast cancer patients that he surveyed.
1. Positive Assertive-active instrumental control to alter oneself or the environment
2. Positive Yielding-acceptance, where one is able to let go of active control without resignation.
3. Negative Assertive-over control, in which active control efforts are used
excessively.
4. Negative Yielding-passivity, fatalistically fails to use control efforts out of feeling helpless.
The study had a testable hypothesis: the ability to use both the positive assertive and yielding/accepting modes (what was termed "optimal control") would result in better psychosocial adjustment to breast cancer.

Utilizing 64 women with first time breast cancer, the results showed that although the resulting interaction between positive assertive and positive yielding control was not statistically significant, there was some evidence to suggest that the interaction between desire for control and positive yielding may lead to better psychosocial adjustment.
 

Behavioral Medicine, Fall 1999

--------------------------------------------------------------
 

A Caring Attitude Can Ease The Burden of Bad News

Ann Quigley shares the results of a study conducted at the Harborview Medical Center in Seattle, showing that the manner in which families are told about a loved-one's death made a strong impact that does NOT fade with time. Patient surveyed stated that the most important attribute of a bad-news-giver is a caring attitude. Patients also indicated that they valued having a knowledgeable news giver who was ready to answer questions, was sympathetic, spoke in a clear manner and was respectful of the family's privacy.
 

Medical Tribune 1999, 40 (17), 8

--------------------------------------------------------------
 

Depression and Hopelessness Predict Desire of Early Death for Terminally Ill

Depression and hopelessness were found to be the most likely predictors of a desire for hastened death among terminally ill cancer patients. Dr. William Breitbart from the Memorial Sloan-Kettering Cancer Center evaluated 92 terminally ill cancer patients to identify factors associated with a wish to hasten their death. Sixteen patients (17%) met criteria for having a high desire for hastened death. Depression scores were moderately high in all 92 patients, as were measures of pessimism, and 15 of 89 patients interviewed met criteria for a major depressive episode. Patients diagnosed with major depression were four times more likely to wish for hastened death.
 

Journal of the American Medical Association 2000; 284: 2907-2911

--------------------------------------------------------------
 

Complementary and Alternative Therapies With Cancer

In an article entitled, "The ABCs of Complementary and Alternative Therapies and Cancer Treatment," Katen Moore and Libby Schmais provide a list of the "complementary therapies that we have found most commonly requested by cancer patients and used in the management of symptoms of cancer treatment." The most commonly requested CAM therapies include:

Oncology Issues 2000, 15(6):20-22

--------------------------------------------------------------
Larry Lachman, PsyD is a Registered Psychologist at Family Service Agency of Monterey County and a Consultant with Psychooncology Associates, where he conducts therapy with cancer patients and their families.
     Dr.Lachman leads a weekly cancer patient therapy group, two bereavement therapy groups and is working on two cancer related books: Seasons of Survival and Under The Hammer of Fate. His psycho-social cancer related web resource center is located at: http://www.seasonsofsurvival.com/

---