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Psychosocial Impact of Breast Cancer Hoping and Coping VideoTranscript
��� ا������� �����ن ا�� ي� ا��� ا� � (�س ا�'& و%$�وز ا��!
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Professional Oncology Education Psychosocial Impact of Breast Cancer Hoping and Coping Time: 49:03
ا��2,35 ا��4�� -� �23 ا�ورام
��� ا������� �����ن ا�� ي� ا��� ا� � (�س ا�'& و%$�وز ا��!
49:03: 7'6ا�
Lakshmi Rai Naik, MA, LCSW Assistant Director Department of Social Work The University of Texas MD Anderson Cancer Center
=>�' ,?,� ة �E, ، أ<=�B, ا�����, إآ3,���' ،G+�/ راي ��Hآ� +�ة '��� ة'
' ا������, I2 ا��J �����3ن ا���NO �$�'5 %?��س" إم دي أ/ رL*ن"'�آ7
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Psychosocial Impact Psychosocial Impact
of Breast Cancerof Breast Cancer
Hoping and CopingHoping and Coping
Lakshmi Rai Naik, MA, LCSW
Assistant Director
Department of Social Work
Hi, I am Lakshmi Naik, an Assistant Director in the
Department of Social Work at MD Anderson Cancer
Center. Today, I will be speaking about the psychosocial
impact of breast cancer, hoping and coping.
� �� ��آ� �� ����، ا�����ة ا�����ة ���� ا����� ا�� ���أه ، أ�� �آ� &�234ث إ��0 ا�%م / ا.-� . إم دي أ��ر&%ن �$��#�ن�� ا���56 ا��
. �$��#�ن وآ5� >�س ا.�: و93�وز ا���62
2
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
ObjectivesObjectivesObjectivesObjectives
• To understand the psychosocial impact of breast cancer
• To more effectively meet the emotional and
relationship needs of patients with breast cancer by
integrating psychosocial assessments and interventions
as part of the treatment and follow-up process
• To gain a better understanding about the possible
resources among the various professionals and staff
• To increase awareness among medical teams of
the process for assessment, tools used and how
to direct referrals
The objectives of this presentation are: to first understand
the psychosocial impact of breast cancer; to more
effectively meet the emotional and relationship needs of
patients with breast cancer by integrating psychosocial
assessments and interventions as part of the treatment and
follow-up process; to gain a better understanding about
the possible resources among various professionals and
staff; and to increase awareness amongst medical teams
of the process for assessment, some of the tools we use,
and how to direct referrals.
�� ����� � ، أو�: 3 �A: أه�اف ه?ا ا�<�ض ا��� ��C ا.-� ا���56 ا�� ���ت ا�%��ا�� و�/ أ�: ���#�ن ا��Aي، وذ�� Fا� �G$3ت��� Fا�
�0: أآ�A �<��� ��ى ���H�ت � ��� ا�� <$�� �9%ا�K ا�< J�ت ا�� �P$� �� &�#�ن ا��Aي / #��O إد��ج ا� ���ت وا��Mاءات ا��56� ا�
� ا�< ج وا�� ��<�؛ و$�ا�%U%ل إ��C� S أ�H: .و��R ا�?�/ �/ -� ��YM��� ���C60 ����3 ا�����ة �/ �/ �� $X ا.WP�V/ و#%ا�J ا�<�:؛
Sإ� Z>� ض�ز��دة ا�%� �/ 5U%ف ا��5ق ا�]G� �<�$� ا� ��، و ���C�، وآ5� 3%�[ اFM��ت�� � .ا.دوات ا�
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and CopingMD Anderson Cancer Center Goals and MD Anderson Cancer Center Goals and MD Anderson Cancer Center Goals and MD Anderson Cancer Center Goals and Strategies for Future Achievement Strategies for Future Achievement Strategies for Future Achievement Strategies for Future Achievement 2005200520052005----2010201020102010
• Strategy 1.4: “We will continue to enhance the patient
experience by providing counseling, compassion, and
hope in a supportive environment”
• Vision: “Every patient’s emotional needs are assessed
and identified providing referrals to the appropriate
psychosocial service throughout the entire spectrum of
care at MD Anderson Cancer Center”
According to the MD Anderson Strategic Vision,
Strategy 1.4 states, “We will continue to enhance the
patient experience by providing counseling, compassion
and hope in a supportive environment” by meeting “every
patient’s emotional needs that will be assessed and
identified, providing referrals to the appropriate
psychosocial services throughout the entire spectrum of
care at MD Anderson Cancer Center.”
�ا39� & �ا39�، 63_ اMو��� ��ؤ�� إم دي أ��ر&%ن اMو&1.4 S$ �6�/ #��O ����3 "أ SY��/ ���93 ا��23 S$&6%اU: ا�<�:
��ة��� �R� �� :�.و>�س ا X#�> G$3� وذ�� �/ P ل" ا���%رة وا�" Sإ� ���FM، وا�و���23ه �C��3 �>� Z���$� �� ���ت ا�%��اFا� ���آ����ت ا��56� ا��6��G& �� أي �/ �9��ت ا����� ا�� %ا��ة �� ��آ� إم ا�
". دي أ��ر&%ن �$��#�ن
3
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
“I will remember that I do not treat a fever chart,
a cancerous growth, but a sick human being, whose
illness may affect the person’s family and economic
stability. My responsibility includes these related
problems, if I am to care adequately for the sick.”
A modern Hippocratic Oath, written by Louis Lasagna, M.D., 1964
Dr. Louis Lasagna in 1964 stated, “I will remember that I
do not treat a fever chart, a cancerous growth, but a sick
human being, whose illness may affect the patient’s
family and economic stability. My responsibility
includes these related problems, if I am to care
adequately for the sick.”
�م / �Uح ا��آ %ر ��� � أ>3��h� : 6أ� &34?آ�: "J�e�%�1964 V �زا��، �: �h آ�V/ ر&� ���� ��ر��ت ا��2�#�& %��ارة، و� �h ��9د
$S أ&�3[ و$S ا& ��اره� �-i� �J ه?ا ]Yو�� ،Z��� ي��� W�ديJا� .� �G&�6�ا� ����jG6 أن 3��: �ا����C ،Z?او��0 أ�Jم ا�� ". ا����آ: ا�� �ا�]� ��h ه?i��kو���3
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
TreatingTreatingTreatingTreating the Whole Patientthe Whole Patientthe Whole Patientthe Whole Patient
Emotional
Function
Physical
Health
Spirituality
PsychosocialRefers to the social, psychological,
emotional, spiritual, quality of life and
functional aspects of person’s life
And so our goal is to look at the cancer patient in relation
with the patient’s environment; treating the whole
patient’s physical health, spiritual health, emotional
health, psychological functioning in the cultural and
social context of his life.
� إ�Z��� S ا���#�ن �/ زاو�� ا�G�R ا� � �mن ه��6� ه% ا�l6 ،و�/ -��n> ؛�C�h� :��> � ا�� oF ���� وا��وF� وا�%��ا�G�2 ا�Wا�
��� 0: � 0��: وآ?�� ا.داء ا���56 �� ا���ق ا��A��� وا���� Z���$�]3�2�.
4
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
“Psychosocial health services are psychological and
social services and interventions that enable patients,
their families, and health care providers to optimize
biomedical health care and to manage the
psychological/behavioral and social aspects of illness
and its consequences so as to promote better health.”
IOM Brief Report 2008. Cancer care for the whole patient: Meeting psychosocial health needs.
Definition of Psychosocial Health ServicesDefinition of Psychosocial Health ServicesDefinition of Psychosocial Health ServicesDefinition of Psychosocial Health Services
So, what do we mean and how do we define psychosocial
health services? The Institute of Medicine of the United
States brought out a report in 2008 titled: Cancer Care for
the Whole Patient: Meeting Psychosocial Health Needs,
where they say, “Psychosocial health services are
psychological and social services and interventions that
enable patients, their families and healthcare providers to
optimize biomedical health care and to manage the
psychological, behavioral and social aspects of illness
and consequences so as to promote better health.”
�<��C�؟ �6�ء و Xوآ ��� $[، ��ذا �<�6 �����ت ا��2W ا��56� ا��ا�<6��� ���ض ا���#�ن �<6%ان 2008أ�Uر �<�C ا�]K ����3ا �� �م
�: �$���Z آ0:�� ���ت ا��2W ا��56� ا��Fا �G$3 ]� ء�ت : "����P� ه� 3$� ا�����ت وا��Mاءات ا��56��� ا��2W ا��56� ا�� �2Wا� ���� ا� �P$� ا� � 3�0/ ا���SY وأ&�ه� و����� ا���� وا���/ ����3 أ�A: ر��� 2U� G#� F%�� وا� <��: �h ا�9%ا�K ا��56� �2% �<�ز �/ ا�2��� S$ ]3�>G3ض و��$� ��� وا��$%آ� وا��
�2Wا�. "
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
The Challenge and Opportunity The Challenge and Opportunity The Challenge and Opportunity The Challenge and Opportunity
• To understand that psychosocial barriers and
emotional health of patients and their family
members are as crucial as their medical
treatment in the cancer journey
So, what is the challenge and opportunity? Our
challenge, basic, is to understand that psychosocial
barriers and emotional health of patients and their family
members are as crucial as their medical treatment in the
cancer journey. And so, one cannot happen without the
other.
�A: إن ا��5ص؟ ه� ا� ��2�ت وأ�/ ه� �� و�0/� ]Cا�%��� ا� �2ي ا�?ي ��� وا��2W ا�%��ا�� ا.&�س �� إدراك أن ا�<%اOV ا��56� ا���$��SY وأ��اد أ&�ه� � �3: �� ا.ه�� / ا�< ج ا�]�G ا����م ��
. � ��0/ أن � O�2 أ�Fه�� دون ا�Pvو�/ -�، . رF$� �2�ر�� ا���#�ن
5
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Meeting the ChallengeMeeting the ChallengeMeeting the ChallengeMeeting the Challenge
• Provide a culture of compassion in which patients’ emotional
concerns related to cancer treatment are acknowledged and
supported by MD Anderson faculty and staff in alignment with
various initiatives like: The Psychosocial Council Initiative, The
Relationship Centered Care Model, The Customer Service
Initiative, The Culture of Caring Initiative, The Cancer
Survivorship Initiative
• Increase knowledge about the various professional
psychosocial resources available to support patients and
their family members within MD Anderson
• Provide timely referrals to psychosocial professionals
so that patients and family members may access appropriate
support quickly
How do we meet this challenge? We meet this challenge
by providing a culture of compassion in which every
patient’s emotional concerns related to treatment are
acknowledged and supported by everyone in the
institution. We have started several initiatives to assist
with this: The Psychosocial Council, The Relationship
Centered Care Model, The Customer Service Initiative,
The Culture of Caring, and The Cancer Survivorship
Initiative. To also increase the knowledge about various
professional psychosocial resources within the institution;
a lot of times there are a lot services that happen within
an institution, but professionals, the physicians, the
nurses, the medical teams, are not always aware of these
supportive services and how patients can be connected to
them. Providing timely referrals to these psychosocial
professionals, so an oncologist is looking at a patient,
looking at the disease status, looking at the chemotherapy
to be started, the patient is in great pain, the patient has a
lot of fatigue, has nausea, has vomiting. A lot of these
problems may be addressed right away, but the patient’s
other problems, which may include emotional pain, the
fear, the anxiety, the panic, the family caregiver issues,
the financial, the social, and the cultural context, are not
always specifically addressed.
ا� �2ي �/ P ل �%3� -���� �2/ ه?ا6%ا�[ &ا� �2ي؟ ه?اآX &6%ا�[ X#�> � ا�� �C� P /�� اف� ا� � �%ا�CC� 0��� ا��%ا>: ا�%��ا�� ا�
O$> � ��� Z���ا� �K آ: ا�<��$/ �� ا��i&�� ���< ج و�����ة �/ ���ة �G�درات �$����ة �� �23O ذ��. ا�< �� �� �6�w �Jو : e$9�
��� �G�درة و��%ذج ا����� ا��<� �6��J >�ت وا����� ا��56� ا��وآ?�� ز��دة . -���� ا����� و�G�درة ا�96�ة �/ ا���#�نو���P ا�<� ء
�/ ا�� �WW/ �� ا��iون �ة���ا�%� �%�%د ا�<��� �/ �%ارد ا�� داP: ا��i&��؛ ��5 ا�A0� �/ ا.F�ن�� 3 %�� ا�A0� ،ا��56� ا��
�/ ا�����ت داP: ا��i&��، إ� أن ا�� �WW/، وا.#G�ء وا����Y�ت �G[وا��5ق ا� �J ا�%� $� ا�����ت ا������ة وآ5� �%0� �$S و ��Vدا
%3]� Z���ا��C$إF��� ا����Z إ�S ه�iء ا�� �WWW2$� . /%ل o2G� ا.ورام �V�WP4� ،K&�6�ا� xJ%ا� �� ��� �� ا��iون ا��56� ا�� ���>� Z���ن ا��إذا آ �وي، و���ا���ض، و�� ��ء ا�< ج ا�0 hYو ��
$� ا����آ: ��0/ �<��9 C� �. �/ أ�� ���w، أو إ�C�د، أو >A�ن، أو �Jء$S ا�5%ر، و�0/ ���آ: ا ��ا��%ف و����Z ا.�Pى �A: ا.�� ا�%��ا
ا���ق وا����آ: ا�� <$�� ����م ا����� �/ أ��اد ا.&�ة، وا�?� وا��$O و����Aوا� ��� � 63�و�C� �� ا�<�دة ؛ا����� وا��� ��U�P رة%W�.
6
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Framework for Care Framework for Care Framework for Care Framework for Care
• Communication
• Education
• Research
• Identify
• Link
• Support
• Coordinate
• Follow up
• Staffing
• Response
• Delivery
And so, the framework of our care for addressing the psychosocial aspects of a patient’s care are, basically, to identify, to assess: what are the distress points and levels of concerns for these patients? How do we link these patients with services? How do we support them? How do we coordinate this? And how do we follow? Most essential elements, communication, education, and research. And more importantly, we must be able to match these with adequate staffing, immediate response, and effective delivery.
��ءOو - ،Gذ� S3ن�T U/�4 '6 أ�& '��5$ ا�$*ا' V/ إ��ر ا����+ ا���&���+ ، ,L�Lأ �=O ، ,ا������ ,��� و%V,,2 ا�+ '*ا�6 ه� '� : -� %!
3\ � ى ه�Zء ا���SY؟ Vء وا�^,\ و'��*+�ت ا��Zه _O�/ `,آ '�ت؟ Iا� G3�O SYه2؟ وا��� آ,` /��\ G3% ا�'*ر؟ وآ,` وآ,` /��/
. NO ا�'�؟ وا�5���b ا�آ�� أه�, ه� ا�%=��ت وا��2,35 وا�E!*ث/�� رة �O �' N�$/ S3,6 هde ا�'*ره* أن '6 ذ�G وا�ه2 V6 ا�,Oو �,-*%
' I2 ا�+ V% ءة���,6 وا�O�$�L ا��*ر+ وآf*د ا�?�-� '6 ا�� . ا�5
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Process Framework Process Framework Process Framework Process Framework
Efficacy defined by
the balance between:
Need Response
Service Delivery
Expectation Experience
• Need
• Service
• Expectation
High Quality Care
• Response
• Delivery
• Experience
This process framework must be so well synchronized to bring out the most effective outcomes. This efficacy of balance between need and response; between service and delivery; expectation and experience, is what will define the quality of our care to our cancer patients.
و+$U أ,� &?HO ��?� +!V\ أ-^& �ن +?*ن إ��ر G3% ا�3�5, '�7ا'�de4 ا����5, -� ا��*ازن O,6 ا�!�� وا�O�$�L -. وأآ��ه� -gB�� ,��5ا�
+��4 وO,6 ا��*�5Jت وا��$�O ا��35, هV%و ' I6 ا�,Oد /*�, �و !+ �'��+ 'SY��� �4 ا�����ن �V/ ا����+ ا��� .
7
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Continuum of CareContinuum of CareContinuum of CareContinuum of Care
Psychosocial care of cancer patients should be an integral
part of their medical care and available at all stages of their
diagnosis, treatment and survivorship and must occur in a seamless continuous manner.
• New patient diagnosed
• Treatment
• Remission
• Recurrence
• Progressive
• Advanced disease
The continuum of care is very long with cancer patients and their treatment. From the point a patient is diagnosed to the patient’s treatments, or when a patient goes into remission, comes back with remission sometimes, the disease gets progressive or if the patient is in the end stages of disease. At each stage, the psychosocial aspect of the patient’s care must be a part of their medical care for us to have the most effective outcomes.
' إ�SY�' S ا�����ن وV3�3 ا����+ ا��L 3�3 إنL 3+*� 24�h� +�i3� . &> + �' ��IH% e,. إO�b ا���+l وj�h� S�k، أو ��-
3k�' �- l+ا���Nأ��اض ��ض؛ا� %�ا� o� ا<�Jو l+5*د ا���+ ا�����ن أk,�/�، أو J 2 ا���ض، أوJ���+ J &kا���ا �- l+ا��� &> +
�3� ,B�4���� و. �ضا��-� آ& '�U$+ ، 3k أن +H?& ا�$�/U ا��!V\ أآ�� � �� ' �l+��3، إن آVا�� ,Epا������� �7ءا '6 ا����+ ا�
� . -gB�� ,��5ا�
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Walk the TalkWalk the TalkWalk the TalkWalk the Talk
We need to walk the talk and we know that each and
every stage has fear, anxiety, anger. There are financial
issues. There are social issues. There are relationship
issues. There are caregiver fatigue issues, caregiver
burden issues. There is physical pain. There is emotional
pain. And not one stage is immune to this fear and
anxiety. At each point, we have different levels of
distress.
�6��<�ف أن آ: ����J �$F� و����9ا���H إ�2�S��� إ /2�63]%ي $S وKHjوا� O$ا��%ف وا�� ���ه6�ك ���V: و. ه6�ك ���V: ����و. �
��� 3 � :W��J >�تو. ا� :V��� ك�ر و. ه6%>�� ��$> ه6�ك ا����V: ا���C� 6%ء� � . ��يه6�ك ا.�� ا�9و. ���م ا����� ��C�M�د و��.G�ء ا�
��F$� وا�Fة ��46ى / ه?ا ا��%ف �x ه6�كو�. ه6�ك ا.�� ا�%��ا��وO$�5 �/ ا�. وا��$ %��ت ���� �6��� ،�[�� .�$Oو�� آ:
8
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
So Why ? So Why ? So Why ? So Why ?
• Frequent crisis intervention
• Lower compliance
• Treatment delays
• Poorer outcomes
• Increased staff time
• Higher costs
• Less able to use resources
• Poorer quality of life
Psychosocial Barriers Lead to:
So, why are we so interested in looking at the
psychosocial impact of cancer on breast cancer patients?
Because we know that barriers lead to frequent crises.
There is panic in the system. There is panic in the
patient’s family. There is panic with the patient’s psyche.
There is lower compliance. The patient does not want to
go for treatment because he is afraid of going through an
MRI procedure. He says, “I would rather die than go
through an MRI”. There are treatment dealings because
there has not been sufficient communication. Or the
patient has not understood, or the patient does not have
the means to get to that test or treatment. This leads to
poorer outcomes, increased staff time, higher costs to the
system. The patients are less able to use resources and
there is poorer quality of life.
� ا� 4-� ا� إ�Sه?ا ا�ه ��م �/ ���6G� ����l6 ���ذا إذا –�� ��56 ا�� OVأن ا�<%ا �$>� �6�i3دي إ��J S �$��#�ن $H��� S�ت &�#�ن ا��Aي؟ .
. ه6�ك ذ� داP: أ&�ة ا����Zو ،6C�ك ذ� داP: ا�l6�م�. أز��ت � �0رةZ���ا� ��5� :Pدا �ن ه6�ك Y<5� �� ا� �ام ا����Z أآ�� . وه6�ك ذ
ج P%�� �/ ا���ور ������Z ���ف �/ ا�?ه�ب � $�� ا�< . ���< ج��#�6j�ا� /����� ��%W أ�H: ا��%ت $S " :و��%ل. ���mاءات ا�
��#�6j�ا� /����� ��%W �A�� ���و��ت �� ا�< ج ".ا���ور � ���9 ا�:Uا% �م 3%��أو .ن ا�����C5� �� Z، أو ،�<�م و�%د �Jر آ�ف �/ ا�
��ت �0�Mأو ا :V�&%ا� Z���$� ل ا� ز��%U%$� ر أو�G Pا� oF Sإ�و� �KG ذ�� �� X>Y ا�6 �zV، وز��دة ا�%xJ ا�?ي �� J�j[ . ا�< ج
��J /0 و. ا�]��J ا�]�G، وار53�ع ا� 0��� X��l6$� �G�6�م� � Z���ا� /�� ا�2�ة أا�& 5�دة �/ �%ارد ا�����ة، آ�� %� .03%ن أ&%أ�J ن
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Cancer Cancer Cancer Cancer •••• Psychosocial Functioning Psychosocial Functioning Psychosocial Functioning Psychosocial Functioning •••• Quality of LifeQuality of LifeQuality of LifeQuality of Life
Cancer patients with serious depression are more likely:
•To be non-compliant with cancer therapy, more likely to
have cancer treatments delayed or reduced
•To eat and sleep less and have poor self-care
•To be less vigilant about disease symptoms and less
able to use proactively those resources that might bring
health improvements
And so, for us, it is so important to know that cancer patients with different levels of emotional distress will show symptoms and behavior problems that impact their quality of life and their psychosocial function. They eat less, they sleep less, they are noncompliant and they are less vigilant about their disease systems.
،2���E إ�,��، وو'6 ��O- ا أن '�SY /?*ن �qO 23� S3ن�6 ا��24 ����ا�����ن ا�e+6 +��ون 3�I�O` '��*+�ت � �4r,Lون ا�^i_ ا�
24Bأدا S324 و�%�,k ,�*/ S3� ��Z% آ& ا��3*آ, ا����Hاض وا�����ا��� ا�������� د-q+ 24آ3*ن آ�,�ت أJ& و+��'*ن . ا�� &J6 ا�����ت أ'
. (,� '7�3',6 وأd�$% �L��k &J أ/24Y�' �rوه2
9
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
DepressionDepressionDepressionDepression
• Patients with compromised immune systems due
to depression have been shown to have higher
incidence rates of cancerFord S et al. Br J Cancer 1994 70(4):767, Holland JC and Rowland J, Handbook of Psycho-
oncology, New York, Oxford University Press, 1989, Brewin C et al. Psych. Med. 1998 28(1): 219
• U.S. National Cancer Institute estimates that 25%
of cancer patients experience major depression
• “Depression and anxiety are highly under-diagnosed
in cancer patients”
Patients with compromised immune systems due to depression have been shown to have higher incidence rates of cancer. And this we know from a study by Jimmie Holland and Rowland in 1989. U.S. National Cancer Institute estimates that 25% of cancer patients experience major depression. Now this is a pretty common statistic and we do know that depression and anxiety are highly underdiagnosed in cancer patients.
JوoE� SYأن ا��� UE�O ,����V. -� ا��74ة ا��O 6,O�=ا���� ذ�G . ا�آ��vب +�5/*ن '6 ار%��ع '5 �ت ا������O O�bsن-�� Jو ورو�/ -� ��م �و%h> 6'1989 . �,Hل دراL أ��اه� �,�� ه*� +�ات ا��45 ا�'�+?� ا�*��� �����3ن إ�S أن V%25 6' Bا��� �-
و5% G3% إSY�'|��O . 5B�} ,B�=k ا�����ن +�5/*ن '6 اآ��vب 3\ � ى '�SY ا�����ن � +IH=�ن Vب وا��vو/!6 /235 أن ا�آ� ، +�i3�
ر ا�?�-�V��O .
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Impact on Breast CanceImpact on Breast CanceImpact on Breast CanceImpact on Breast Cancerrrr
• In a study by Spiegle et al., 86 patients with metastatic breast cancer were randomized to receive either routine oncologic care, alone, or routine oncologic care plus one year of weekly supportive group therapy and self hypnosis
• Survival from the time of randomization was significantly higher in the intervention group (36.6 months compared to 18.9 months)
• A number of studies also draw attention to the high levels of distress beyond the period of initial diagnosis
Ganz PA et al. Cancer 1992 69(7):1729
In a study by Spiegle et al., on 86 patients with metastatic breast cancer who were randomized to receive either routine oncology care, by itself, or routine oncology care with attendance to support groups on a weekly basis for 12 months. The survival time of randomization was significantly higher in the intervention group by almost 100%. That is phenomenal. A number of studies also draw attention to the high levels of distress beyond the period of initial diagnosis.
ي S3�86 -� دراL أ��اه� {i,E& و~<�ون�'�+^ '=�����O Oن ه�، أو kو ,�/V,�3 %2 ا<�,�رهH� 6*ا�V3�� �,B ر��+ ا�ورام ا��و%, �=O ة ر��+ ا�ورام ا��و%,�, إ�Y- إ�k S^*ر '$�*��ت ا����/
ة �� ,�*EL؛{�4ا 12أ � ا�!,�ة -� ا�5,,J S3� ء�VEة ا� ' o/آ�*H5رب ا��V% E��O &> . -� ا���B 100اB, أ�O S3?�,� -� '$�*� ا��
د '6 ا� را�Lت أ+^� ا�/�d�E إ�S و�*د ��oآ�� . وهeا {�ء 'eه&�5 -��ة ا��IH,. ا�و��O S�k ،ة Hت ���, '6 ا��+*��' .
10
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
• Goldberg et al. found high levels of anxiety and depression
in approximately 25% of breast cancer patients at 12 months
following initial diagnosis
• There is evidence that this level can persist for up to two years
or more after diagnosis. Levels of depression and anxiety can
also be higher in those patients with advanced disease, with
pain being an important contributory factor
• Pain and depression impact each other closely and
management of one without the other will not be most effectiveSpecial Section: Cancer, 568 Current Science, Vol. 81, No. 5, 10 September 2001
Impact on Breast CanceImpact on Breast CanceImpact on Breast CanceImpact on Breast Cancerrrr (continued)(continued)(continued)(continued)
Goldberg JA et al. EurJ Surg Oncol. 1992 18(4):327
Ganz PA et al. Cancer 1992 69(7):1729 ; Maunsell E et al. Cancer 1992 70(1):120
And we know that, again, at least 25% of patients feel these symptoms even 12 months after initial diagnosis. And we know that this can extend up to 2 years or even more depending on the traumatic stress disorder that this diagnosis and treatment has imposed on the cancer patients. Again, pain and depression impact each other closely and management of one without the other will not be most effective.
،Gو/!6 /�5ف ذ� ، ,/��ا�eي -� ا���B '6 ا���SY 25ه��ك '�ة 5 '�ور O S�k اض���ا G3�O �5ونH+12 و���ا .,IHا�� 5O �4ا} .
5� �� ى ا��pYاب E% 6 أو أآ��,'�� Sإ� ��% J ة���آ�� /235 أن G3% ا���� ا���%g �6 ا�= ' ا��ذ�G ا��IH,. وا�h5ج � ى '���4EE�+� SY ا�
�� آ& '6 ا��2 وا�آ��vب �5O ��4^5O S3^و. �����ناZ+ ،ة أ<�ى�'� ه�� دون ا�<�kأ N' &'�5���O ,��5- S=Jأ \V!�% 6و� ،\,� . HO?& و
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Breast Cancer Incidence Breast Cancer Incidence Breast Cancer Incidence Breast Cancer Incidence
• As of 2008, there are about 2.5 million women in
the United States who have survived breast cancer
• Breast cancer incidence in women in the United
States is 1 in 8 (about 13%)
• About 40,170 women in the United States were
expected to die in 2009 from breast cancer, though
death rates have been decreasing since 1990. These
decreases are thought to be the result of treatment
advances, earlier detection through screening, and
increased awareness
As of 2008, there are about 2.5 million women in the United States who have survived breast cancer. And 1 in 8, about 13%, have breast cancer in the United States. About 40,000 women in the United States were expected to die in 2009 from breast cancer, although the death rates have decreased considerably since 1990. These decreases are thought to be the result of treatment advances, earlier detection through screening and increased awareness.
'3,*ن ا'�أة -� ا�*�+�ت 2.5، آ�ن ه��ك '� +�Vب '6 2008وS�k ��م ة 'O 6,6 آ& ه��كو. /$���L 6' oن ا�� يkأي '� /��ء 8ا'�أة وا ،
. -� ا�������O O�=' ، Bن ا�� ي -� ا�*�+�ت ا���! ة �V+13ب '6 2009أ�` ا'�أة -� ا�*�+�ت ا���! ة -� ��م 40وآ�ن '�*5J� و-�ة
UE�O ،ي ��ض '5 �ت ا�*-�ة وذ����L Gن ا��I/ا��(2 '6 ا S3����Yت ر��O آ�/O1990 . o=*رة آE,�ة '�e ��م I/ا� G3% أن V�5+و
�^& ا<��Eرات ا��!�ي O �?Eف ا���Hج، وا�آ�h5م -� ا� V�3� $,�/ .وز+�دة ا�*��
11
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Emotional PainEmotional PainEmotional PainEmotional Pain
• The intensity and duration of a patient’s “emotional”discomfort or pain can be sometimes “more crippling”
than the disease itself
• Patients/families have multiple stressors at different stages of their disease, the intensity of which can
change dramatically at different points in the journey
• Emotional comfort is a vital piece of the treatment and “significantly enhances a patient’s overall care”
And again, when we talk about awareness, we want to say awareness amongst the patients, the families, the medical staff, the physicians, the nurses, the social workers, the case managers, the business center people, patient advocates. All of these people being able to work as equal partners in the single goal of providing the most optimum quality of life for our patients. The intensity and duration of a patient’s emotional discomfort of pain can be sometimes more crippling than the disease itself. I have had patients who have felt this pain, this emotional pain that does not allow them to think clearly; does not allow them to want to even go through this treatment anymore even though we have a highly optimistic view of a cure of treatment for their disease. And patients will sometimes say, “Forget it; I do not want to go through this.” And that comes from a sense of deep emotional pain, which has crippled them and we need to do something about it as soon as possible. Patients and families have multiple stressors at different stages of their disease. The intensity can change dramatically at different points in the journey depending on what triggers this patient’s state of mind, and fear or anxiety. There are patients that are terrified by MRI images, patients that are terrified by just seeing the prick of a needle or looking at bandages or smells even. So, emotional comfort is a vital, vital piece of the treatment and significantly enhances a patient’s overall care and also the family’s overall care.
ثو'�ة أ<�ى، !�/ �' �5�� 6�G�eO ا�*�� �/ ، SYى ا��� ا�*�� �وا�2J�p ا��Ep وا���Eء وا�����Yت وا�<=�B,,6 ا������,,6 و' +�ي SYق ا���*Vk 6� 6,5-ا . ا�!��ت وا��5'6,3 -� '�اآ7 ا����ل وا��
م J S3� آ�ء�Hا��5& آ S3� 6+در�J �5,�� ء�Zأن +?*ن ه U$+و ه* %*-,� /*�, k,�ة '��Y��� S3/�ا����واة '6 kف وا . أ�& %!V,\ ه
ة ا��VH ا�*� ا/, ا��� +�5/,�4 ا���+l '6 ا��2 وH� 6?�+�4 أن �و% �j%أآ�� '6 ا���ض ذا d 5V% .O �' V�� ،2��ا Gذ� &��O �5وا} SY�'
�?,� Y*O*ح؛ ���O 24� ���+ � يeا/� ا� 24 � +�,� � أ�2إ/j ذ�G ا��2 ا�*� 24%�r/ 6' 2)ا�� S3� جh5ا� �- �' J �^ا�� �- E)ا�� S�kة ا� + H
�^& ا�h5ج ا�eي +�O� j/*V3ا����ؤل O ء��H�� جh524Y�' . ل*V+ �' �/�,kوأSYا���" :Gذ� �- �' J �^ا�� �- U)؛ � أرG,3� �. " Sإ� Gذ� N��+و
v,} &5��� أن /,3� U$+243، وE?+ \,�� �/ا � %$�d ذ�G -� ا�5H*ر 2�qO و�6?�' oJب و�Jو. أ _i^ت ا��EE�' 6' + +*ا�j ا���SY وأ�Lه2 ا�5
3� ���3ض�Iا�� &kى ا���ا ' S3� ���� %�4 . ا�} �,i�% و+�?6 أن ى /�Vط ر3k ا���ض' S3� ة�,Eرة آ*=O ا��3�I� ، Gوذ� UE�3� �5E%
3\ � +jا�?�'6 وراء %G3% g,�q ا�!�� ا�eه�, �l+��3، أو ا�I*ف، أو Vا� . 6,/���O �+*=6 إ��اء ا��' U����O �5ونH+ SYا��� l5E- Sإ� �r����,��، أو +�I-*ن '6 '$�د رؤ+ 6L ا�Osة، أو ا�iا��
�Bا��وا S�k أو ، pOر�ا، -و. اe� نT وري، و�7ء�Y �'أ ,���ا��اk ا� ' V�4 أن %75ز آ�,�ا ا����+ ا��5' ا��/q} 6'ج، وh5وري '6 ا��Y
. l+��3، وآG�e ا����+ ا��L�� '�5ة�
12
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and CopingHoping and Coping Hoping and Coping Hoping and Coping Hoping and Coping ---- A Dynamic Paradigm A Dynamic Paradigm A Dynamic Paradigm A Dynamic Paradigm Cure Cure Cure Cure •••• Respect Respect Respect Respect •••• Compassion Compassion Compassion Compassion •••• TimeTimeTimeTime
• Medical treatment/physical care
• Emotional comfort
• Communication both with patient and providers, accurate
and timely information, education about
care plan, resources and long term implications
• Comprehensive plan of care
• Emotional support and alleviation of fears and anxiety
• Transition and continuity of care
• Coordination of care and integration of services
within an institutional setting
So, while we are hoping and coping, what are we doing? What is the paradigm for helping patients hope and cope while they are on this journey? Their emotional comfort, the communication to the patient between the providers. So we have a physician who has seen a patient; he has done his notes on the chart, he has talked to the patient briefly, given some details, but the patient has not completely absorbed this. Patient is still very upset, but afraid to talk to the physician. He has gone home and now he has become suicidal. What do we do in situations like this? What is the barrier that came up here? How do we make sure that we have provided the patient with the best possible information, in the best possible way, in a compassionate understanding way, where the patient is able to cope with that information? And if not at that time, what other kind of support system am I building for him to stand up strong? To be able to provide a comprehensive plan of care, sometimes we give them plans of care in bits and pieces. The next step is you go and you get a bone marrow aspiration. So, he goes to bone marrow aspiration. The next step is you come in and get a CT scan. These are bits and pieces of information that don’t not bode well, or help the patient to understand the complete plan. If a patient knows what the complete plan is, it is much easier for the patient to emotionally prepare himself for the next step; transition and continuity of care and the coordination of care and integration of services within an institutional setting.
ا�'& و%$�وز ا��!� ، '� ا�eي س-� ا�*oJ ا�eي /V*م -,�iO jووا�ن، ة ا���S3� SY و/V*م jO؟ ���' �- ' Iه,2 ا�������r*' ا��' �'
��ء ر3k ا�h5ج؟ ا��اk ا�*� ا/, ، �(�س ا�'& و%$�وز ا��!� أ l+ا��� N' &bتوا��*ا�' Iا� �' V' 6,O .- 6 '�+^�؛+�� U,E� ��'�'q
ن 'j%�rkh -� ا�$ ول، و%?N' 23 ا���+�J�O l^�ب، وأ�l5O Sp ودو�-����+l '� زال . ا����b,&، و�?6 ا���+U�*��+ 2� l ذ�HO G?& آ�'&
U,Epا� Sث إ� ��7$�، و�?�SHI+ j ا��!' . o!Ebوأ ،j�7�' Sد إ���'� ذ�G ا�B�5\ ا�eي و��ذا /�5& -� '*اJ` آde4؟ -. � +j ',*ل ا/�!�ر+
5& ���qآ '6 أ/�� وه��؟ �4f ه�� '�ذا /J ��3bا�إأو S &^-أ l+��� ، �?�' V+�� &^-qO ، ���4 رk ، �,k,� وا��35*'�ت ا���?�' V+�pO
+��?6 ا���+l '6 %$�وز ا��!� 'h> 6ل G3% ا��35*'�ت؟ وإذا �2 +?6 �- ��?�' Gاذ�eه ��- ،oJ*ة ه� ا� ا�/*اع ا�<�ى '6 '�r*'�ت ا����/
� أJا�� �4' jة؟ و�*VO �� �?� +��N,p أن +=��?� ،�/�,k6 '6 وأ?��/ �?� +���3� 3'�} p> 2+ V%، �/ l+ا��� �v,H- �v,} +ا���� _pIO .
��V ا��r5م و� _�). /�Iع ا�2r5(ا�pI*ة ا����, ه� أن %eه��s Uاء {��ءO2 وr5ع ا��I�� _�ه� %�4,3ا�pI*ة ا��� و. ���s j�*�+ ،j,3اء {
�5pV' �+*=% اء��s ق . ا�!^*ر�� ر +�� و'�J 6� رة�E� *ا هeوه%IO �HE,�، أو %��� ا���+S3� l -24 ا�pI ا��� �ا��35*'�ت '6
4& � ا ,-Tذا أqO .kآ��43L�ا�?�'3 ، -�,?*ن '6 ا pI��O ��3� l+ا��� _5 اد و� ا/,� �pI3*ة ا����, ؛ ا���p> 6,O &V*ات ا����Lا� j,3� +�
�LZت دا<& '!,_ ا���' Iا����+ و%?�'& ا� \,�� . وا���Lار+��4 و%
13
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Coping with Coping with Coping with Coping with
• Pain, swelling, body changes
• Feeling overwhelmed
• Anxious
• Fearful
• Relationships
• Life changes
• Getting back to “normal”
How do people really cope ?
�I just can’t take this constant stress anymore not knowing
what is going to happen.
�I am going to shoot that doctor. He told me I was going to die!
�I am going to beat this. I am NOT going to die.
So the coordination outside of the institution is different
than the coordination within the institution. Has the
physician called the PA? Has the physician called the
social worker? Has the PA talked with the pharmacist?
Has the nurse spoken with the nutritionist? This is
coordination of care where everybody is looking at every
aspect of the patient’s care. The pain, the feeling
overwhelmed, anxiety, fear, life changes and getting back
to normal. How do people really cope? “I just cannot
take this constant stress anymore not knowing what is
going to happen”. There is this constant sense of dread,
so how do I stop this dread for my patient? “I am going
to shoot that doctor, he told me I was going to die”. Now
what brings about a response like this? When a physician
has with all good intentions provided the patient with the
most correct information as a scientist, and still faces a
response that can be as violent and aggressive as this.
The reason is that we did not quite understand or gauge
the patient’s emotional state at that point. And to be able
to break that piece of news, or present that piece of news
in a different manner, is the skill we need to pick up. “I
am going to beat this; I am not going to die”. So, we
have a lot of patients who want to fight, who want to beat
it, who are hopeful that they are going to live forever.
� O�6 6[ داC$P� إذا�� X$ �� ��&i�رج ا��P .� KG[ا� :W3ا :C�؟ و� ا�]GK؟ ������ ه: �23ث وه: اW3: ا�]G� K�WP.��V ا��
ه: x-�23 ا����h� �Y أWP��V ا� j?��؟ و���� ا�]Gh� K ا�W���؟ K�[ � �6O ا�����؛ F�� �l6� oh ا.��اد �� آ��� �%ا6>�ه?ا ا�?ي
Z���$� �����ا� ���ت j3�اوا��%ف وا��$O وا��<%ر �����C وا.��، . ا���>G[ة ا��ا�2 Sة وا�<%دة إ��ا�2 . S$آX �<�: ا�6�س �� ا��2��
� ���660 23�: ا����� �/ ذ�� ا�jH| ا���56 ا��� �� "93�وز ا���62؟ -�� w<%ر �� �� ����ه�G، و" .�� ا�%xJ ا�?ي � أ$� �[ �� ا�?ي &�2ث
&J4%م "�H؟ ��� ا�?ي ���660 �$[ ��M�ف ذ�� ا��<%ر ����ه�G ��ى ���$S و�w ا��%ت �6��� أ�GP؛ ��� أKG[ذ�� ا� S$ ".�m# ق ا�6�ر
KG[ا� ]� ا�?ي ��ود xJ%ا؟ �� ا�?Cوراء رد �<: آ KGا�� �ن، �vوا�[ �%ا�[ رد m� ،���>ت آ��%$>� /� ]��� �� }U4� �$��آ �� /�2� Z���ا�
�C�6� أو J�&6� �$2��� وا��KG وراء ذ�� ه% �م. �<: 65� أو �وا�� آC?ا�$F��3$� ا� �� Z���$� ��2 �ج إ�C� �$>3 S�رة �V�93 3$� و�2/ . ا�%��ا��5$ �� ����[� �CY�$S ه?ا؛ و�/ أ�%ت. "ا.GP�ر، أو �W �4& ."
W�ر ه6� ���6� و�ا�A0� �/ ا���SY ا��ا>G/ �� �2�ر�� ا���ض، وا� ،]$/$V�5 .�� ا�<n �~�� ا��
14
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
• How do I tell my daughter I’m sick?
• Where can I talk to other cancer patients
about treatment?
• Are the changes in my sex drive normal?
• What if I can’t afford the expenses?
• What things should I tell my family?
How do we manage this expectation? How do we take them along on the continuum from the best to the worst, and from the worst to the best? Patients have questions all the time. “How do I tell my daughter I am sick?” “Where can I talk to other cancer patients about treatment?” “Are the changes in my sex drive normal?” Now how many patients would talk to you about this on a daily basis unless you really ask them? And sometimes, even if you ask them, they are not going to tell you. So, what kind of skills do we need to get an understanding for some of these issues and are these issues important? Absolutely, because that impacts the patient’s quality of life. “What if I cannot afford these expenses?” “What things should I tell my family?”
�� أن /e>qهS3� 2 �*ل ��� ا��N' &'�5 ذ�G ا��*NJ؟ آ,` +�?�آ,` +�? 24+ � SY-^&؟ ا����ا Sأ إ�*L�أ، و'6 ا*L�ا S-^& إ��ا��3�3 '6 ا
3vLأ ��B؟. "دا�Y��O ���Oا �E>qL `,آ" " Sث إ� �� ا��!�أ+6 +�?ه& ا��i,�ات ا��� %! ث -� " "'�SY ا�����ن ا�<�+qHO 6ن ا�h5ج؟
آ2 '�+^� +�?6 أن +�! ث إ�,G -� هde ا�'� " (��E ا�$��, �E,5, ؟ر *� S�k ،ن�,k�ا l5O �-؟ وNJا�*ا �- &Bا��� o/أ o�آ& +*م، إ� إذا آ
أ/*اع ا���4رات ا��� /!���b*3� �4*ل إ�S ه� �� -. �EI+ 63- ،24��qLوك5% -24 أ-^& �G3% l5E ا����B&، وه& ��Z% �4/� ،NEp��O �4 ؟' S3�
l+ة ا����,k ,�*/" .{,�ء " "'�ذا �* �2 أ%�?6 '6 %!�& ا��?��,`؟�ا �'%�L�4,3 أ� N3أن أ� �iE� " ؟�ا��� +
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
• How do I make sure I won’t be kept alive by a machine?
• Am I supposed to feel sad all that time?
• Why do my husband and I fight so much now?
• What if someone is abusing me?
• What does hospice mean?
• What if I lose my job?
“How can I tell my family?” “I do not want my wife going crazy and jumping off the roof because I have this diagnosis because that is not going to help.” “How can I manage this?” “How do I make sure I will not be kept alive by a machine?” “Am I supposed to feel sad all the time?” “Why do my husband and I fight so much?” “Our relationships have changed and some things have gotten worse.” What if someone is abusing? “What does hospice mean?” “I do not have anything like hospice in my country or in the city where I live.” “Is that another hospital?” “Is that another service?” “What if I lose my job?”
�7 '6 ا���p أن � أر+ أن +6$ ��*ن زو��� و" "آ,` أ<�E أ�L%�؟"V% ي /�UE�O-�5 ذ�G ا���ض، $+ 6� G�e". "؟Gذ� N' &'�5%آ,` " "آ,` أ
ا�!,�ة O*اpL ~� ؟,J S3� �B�VO6 +�2 إ� j/أ ه& '6 " "�� أن أ%qآ�� �*ال ا�*oJ؟+7k SVOض أن أ���" ؟���ذا أ%���H أ/� وزو�� آ�,�ا" "ا��
�� و�bرت l5O ا�'*ر أL*أ"�Jh� ت�,i% V� ". kء أ�Lذا �* أ�'3 ي أو " "'� '5�S دار ر��+ ا�!��ت ا���q<�ة"'�5'��3؟ EO �*+ �
O�+ ور ر��+ ا�!��ت ا���q<�ة��� &��S ~<�أه� ". "� {�ء '��H��'؟ " ' ؟"I؟" "أه� /*ع ~<� '6 ا����,fت و V- *� ذا�' "
15
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Hoping to Hoping to Hoping to Hoping to
• Feel better
• Focus on possibilities
• Lead a healthier meaningful life
• Strengthen body and mind
• Take charge
• Build connections with survivors, counselors
• Set new goals
• Adjust to a new normal
“What are my alternatives to manage this disease” and “what am I hoping all the time?” The patient is saying, “I hope to feel better” because most patients come with a hope that they will be cured. And again it is up to the professional to be able to navigate through this and manage that expectation in a very tactful manner, where we are looking at cancer as a more chronic illness, where there is no cure, so to speak, for diseases like diabetes, And so cancer, in much the same way, may be a long-term phenomenon with no actual cure, but maybe remission, maybe stabilization of disease. And maybe we can say that this disease will never come back for the next 10 to 15 to 20 years or over the lifetime. But again, it is about managing expectations where patients are able to move along the continuum of care with much more comfort. To focus on the possibilities of what can happen in a positive direction. Lead a healthier, more meaningful life, even in the face of a terminal nature of any type of disease, if it is terminal. Strengthen body and mind. Take charge. Help the patient if the patient wants to take charge, be in control. And so, always being told do this, do not do that, eat this, must have this, can wear a patient down and make him feel like he has lost control. Build connections with survivors, counselors, they want to set new goals, you want to help them set new goals. “Okay, so I was a marathon runner yesterday and I cannot do that anymore, but what is my next alternative. Maybe I can start painting. Maybe I can start cooking lessons.” There are so many different alternatives one can look at and there is such a thing as creative problem- solving, which most patients themselves are able to come up with the solutions as long as they know they have the
اB& ا���*"Eا���ضا'� ا� Gذ� N' &'�5�3� �'�'ي "و" -�ة أe6 �� '� ا�?�+
jVVk؟ أن ~'& -� أن أoJ*ى ا� ' S3� " l+ل ا���*V+" 5*رHا� �- &'~6�!�O "ء��Hن ~'6,3 -� ا�*%q+ SY2 ا���r5' ن� Gو'�ة أ<�ى، . وذ�
T- Gن ا�'� +��N إ�S ا���I. -� ا���?6 '6 ا��,�ز ذ�G وا��N' &'�5 ذ� �r�/ �,k ، +�i3� L��k V+�pO NJ*ا�إا�� S �Y�' dر�E���O ن�����
��ء �j، آ�� } � ،��'7'� E����O ه* ا�!�ل &����Oاض '�& ا��?�ي، و�' +�?6 أ+^� �����3ن أن +�f &?Hه�ة �*+3 ا��& � {��ء ,5O k Sإ�
,V,Vk� ��� ا���اض، ور�V��+ ��O ا���ض'�I% ��O�4، ور .&O ���?�+� �Jد' ، 20أو 15أو 10'�ة أ<�ى �� ة *دا�V*ل إن ا���ض �6 +5L
ى ا�!,�ة' S3� ��Oأو ر .`J*�+ �'�و�?6 ا ، ,�'�ة أ<�ى، �S3 آ,�*ن '6 ا���3�3L �E� &V ا����+ ?��+ �,k SY�5ت ا���J*% N' &'�5ا��
�k�,%وه2 أآ�� ار .pO ث �+V ا���آ,S3� 7 ا����kت '� +�?6 أن +! ,O�$+ي /*ع . إ� ,B�4��,� k,�ة أ�b، و'���ة، f �- S�k& ا�Ep,5 ا�
ن وا�eه6. '6 ا�'�اض، S�k و�* آ�ن -� ا���اk& ا�<,�ةEا� +*V% . ا���+l إذا آ�ن را(E� -� %*�� ز'�م ا���Zو�,. %*�� ا���Zو�, ��L ��ء و. وز'�م ا��,�pةOو�ا j,�*% S3� 'او ا'� �l+��3؛ �T- ،j,3ن ا��
*!/ : ،G5& ذ��% � ،Gولا-5& ذ���هeا، +$G,3� U ذ�q} 6' ،G/�4 إ/�4ك % j/q�5 وآH+ j35و� l+ا��� Jة�p,ا�� V- . '�Jتإ�Jh� 6' 6,���'N ا�
ة، وأ/o %*د + أه اف �+ ا���ض وا�����Hر+E)�+ 24- ،6*ن -� %! ة+ أه اف �+ !% S3� 24% ���'" .o� آV� ،���k ق�EL �- �'��O
Gذ� �- �' J �^ا�� N,p�Lو� أ ،�/*� +& ا�<� . '�راEو�?6، '� ا� ء -� ا��2L. أ'�'�Eا� ���?�+ ��Oدروس -� . ر �V3% �- ء Eا� ���?�+�4pأ+^� -." ا� G�e�4، وآ�!O 6?�+ ا��� �3�Iا�� &Bا E6 ا�' + 4��ك ا�5
(U3 ا���SY '6 +�?6 إ+$�د 3k*ل '�E?�ة ��H�3آ&، k,� +��?6 أ ون ا����/ ة وا����� ة، دا'ا��*b& إ�3k S*ل '�$,L 24/qO 23� S3� ا*
+ � �5,E� NYو N' `,?'& -� ا���وا.
16
support and the resource, And hoping to adjust to a new normal.
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Hoping to Hoping to Hoping to Hoping to
How do people really cope ?
�I will do what it takes to get well but I will also plan
for the worst.
�I am going to try and live a normal life even though
so much has changed.
�This cancer has given me a new perspective on life.
Now, pre-cancer and post-cancer are two different
phases. And to know that this is a life-changing event in
the life of any patient. And how do people really cope?
“I will do what it takes to get well, but I will also plan for
the worst.” Some patients will say that. Whereas some
will say, “I am going to try and live a normal life even
though so much has changed.” And some others will say,
“This cancer has given me a new perspective on life.”
These are all ways people cope. Some cope by being
angry, some cope by being depressed, and some cope by
saying, “I am going to take the next step and move
forward.” And so, we have got to be able to gauge,
where is this patient in that journey of coping and
hoping?
6�F�� �$F�� �>3 ،� GJ: اUM��� �����#�ن و��F$� �� �<� ا���#�ن $F�� 5$ وإذا �� $�6� أ�C� -�F :A�3� �j�ا �2�ة أي . / 3����/ ��Z��� .ا� :�>� X0� Z>� %ل�وز ا���62؟ &�93 S$6�س �� ا��2��
SY��ا��]| "ا� hY4& �60و&<� ��0 أ�23/، و� �� ��4?ل آ: �&F4&n�ول أن أ: "وا�Z>G ا�Pv &�%ل" .G�23� �~&%أ �>G# ة�F
�C� �j3 ا�?ي �A0ا��>� �/ ا� S$��� ��626 : "و&�%ل ��Pون ".A�3: 3$� و&�C� 49$� :V� ا�6�س ". �ة�2$S اا���#�ن �l6%را ����ا
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�K9 أن �0%ن J�در�/ $J S�س �%hY ا����Z �� رF$� 93�وز ،و�?�� ا���62 و>�س ا.�:؟
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Impact on Family and Caregivers Impact on Family and Caregivers Impact on Family and Caregivers Impact on Family and Caregivers
• Shock of diagnosis
• Increased caregiving demands
• Relationships
• Role strain
• Internalized feelings
• Reluctance to discuss physical change
• Fear of losing partner
• Resources
• Coping
Says a survivor: “The support of my family has truly helped me to better cope with the challenges I’ve faced after my cancer diagnosis.”
Another very, very important aspect, which we
sometimes tend to forget, because we are more focused
on the disease itself and curing that disease, but the
patient’s family and caregivers are an extremely
important part of this person. The shock of the diagnosis
that the patient feels is felt equally or sometimes even
more by the family and caregivers. These increasing
caregiving demands on a wife who never used to work,
was at home taking care of her children and bringing
children back from school, and making good hot meals
for the family now goes to work. Now has to start a
whole different lifestyle of working and coping with the
disease of her spouse. Relationships change. The roles
have changed and so relationships change. There are
internalized feelings, “I am angry, but I do not want to
tell my sister or my brother about what I am feeling
because that will further stress them out.” Reluctance to
discuss physical change and often spouses of cancer
��lا ،�C���� Sإ� ���F69{ أ� � �/ �/ ا�9%ا�K ا��C�� ��ا ��ا، وا�$S ا���ض ذا3[، و$S �<���9 ذ�� ا���ض، وه% أن � �آ��� ا. �Gآ
��?� �G�6��� ���j$� ��C� 0$%ن ��ءا�� ]� ���أ&�ة ا����Z و����� ا��_����. ا� ��� ]�$�<� �C� ا����Z ��ى � � �<� �C� ������W ا�� _
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�3S أو�ده� و3 �C � �� x��/ ا���ر&� وh6W3 ا�%�G�ت �CG$9آ���Gء �� ��| F�ة و�<�6 ذ�� ا. ا����6P ا��C� C3�&.�، ��3ج اvن �$<�:
�5$ ا� j� �� . / ا�<�: وا� <��: �h ا���ض ا�?ي أU�ب ا��وج آ$���� داP$�، . ا�< J�ت ����� j3�ت ا.دوار؛ وآ?. ا�< J�ت��� ��A�" ��أ
F ي����� ���w أو � ��w �GPو��60 �/ أ ،KY�<S /� أز�� ���C$�� ا� j ".ا�jH| ا���56 J�6� �� دد� ��، وآA�ا �� �5j: ا��Gات ا��
�[P ن أو أي ��ض�#����ن، ��ا���# SY�� أزواج ���Uإ _��3 ،�P� وذ�� S$�م ا� �KG �� ز��دة ا�jH| ا���56 S$ �CU�2� ا�l���ذا &�4<: "ا��%ف �/ ���ان ���w ا�2�ة وآ�� ��%ل أ�F ا�6��/، . ا��وج
�� �%ارد " ".F ���w��3 � ���660 ا�<n ��ون زو�� أو. �<� ذ��] إن �����ة " "،ا�����ة ا�� %ا��ة، وآX ���660 ا� <��: �h ا.�� ���
�C Cوا� � $S ا� ��2�ت ا� :H0: أ��� K$j $S ا� ��F �63�أ&��3 &�
17
patients have gone undiagnosed, with cancer or some
other serious illnesses, because they did not want to
impose further stress on the spouse. The fear of losing a
partner and, “What am I going to do next. I cannot live
without my spouse or without my partner.” “What kind
of resources are there and how will I cope with this whole
thing.” Says a survivor, “The support of my family has
truly helped me to better cope with the challenges I have
faced after my cancer diagnosis.”
� �����#�ن��Uإ _��3 �>�."
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
It’s unpredictable
It’s a roller coaster
It is unpredictable. It is a roller coaster. There is no
point in time where a physician can truly say, “Hey, you
are going to live forever,” or, “You are going to live for
20 years,” because none of us is a God. However, we all
do know that there are ups and downs in every phase of
life, and with cancer, it is even more unpredictable. And
all we can do is strengthen these patients along their
roller coaster journey and make sure we are able to pick
them up when they fall off the coaster.
G6 � . أGw[ ��آ%ب &5�6 ا�� ه� ا��وارةإ�[ . �[ iإ�[ أ�� � ��0/ ا� �Fا�U :0� �� xJأن ��%ل �� و KG# 0/ .ي��" n>، ���60 ا��6�F
<n "أو " �~��&20 ���،" Kj<$� ا�� � �ا �6�Fن أ. . �>�� �$>�و�660� �G�6 ���ض أن ��h ��اF: ا�2�ة 3�� �2��ت U<%د وهG%ط، و���
hJ% وآ: �� ��660� �<$[ ه% �����ة . ا���#�ن، �mن ا.�� أآ�A �<�ا �/ ا� S$$S 3$� ا��5�6 ا��وارة، وأن �0%ن J�در�/ �C $Fء ر�أ-6 �� SY��ا�
�C6� &�]%ا �ذه� إذا ���� . إ
18
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
“I’ve been touched by the smallest gestures - a
squeeze of the hand, a gentle touch, a reassuring
word. In some ways these quiet acts of humanity
have felt more healing than the high-dose radiation
and chemotherapy that hold the hope of a cure.”
Kenneth B. Schwartz
“I’ve been touched by the smallest gestures, a squeeze of
the hand, a gentle touch, or a reassuring word. In some
ways, these quiet acts of humanity have felt more healing
than the high-dose radiation and chemotherapy that hold
the hope of a cure.” Kenneth Schwartz said this.
��، أو آ$�� �]��6R أو jY]� �� ؛�5$ �ت��� 43-�ت �/ أJ: ا" �F ���� . � أآ�A إ��اء �/ ��Wا� �����Mت ا���W و�/ �<Z ا�6%ا�F، آ��x 3$� ا���4: �/ وراCV� ا��5�ء � �ت اwM<�ع ا�<��� وا�< ج ا�0��وي ا���. "
e3ار%w o6آ ]��J �� ه?ا .
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
A Comprehensive ApproachA Comprehensive ApproachA Comprehensive ApproachA Comprehensive Approach
• Psychosocial assessments
• Psychosocial counseling and cognitive behavioral interventions
• Transition planning
• Education and referral
• Advocacy
• Program development, monitoring and follow-up
So, at the end of the day, what we want to look at, is a
comprehensive approach institution-wide, wherever this
institution may be, wherever this cancer care is being
provided, to make sure that we have a comprehensive
approach towards cancer care, in that, other than the
medical assessments and the treatments, that we are on a
parallel front, dealing with the psychosocial aspect of a
patient’s care. Which means psychosocial assessments,
counseling and cognitive behavioral interventions,
transition planning, education and referral, advocacy,
program development, monitoring and follow-up.
2 �ج و��C��� ا.�� -�?ا �� - ،��&i�ى ا�% �� S$ :��w zC� o2� Sإ�أ�6�� آ��x 3$� ا��i&��، وFA�� ��3م ا����� ���SY ا���#�ن، �$ 4آ� �/
� o2� ،ن�ا���# SY�� ����w zC��93 :�k ر OG[3 h� :��> � ا� %ازي �h ا� ���ت ��� Z���ا� ����� ��� ا�9%ا�K ا��56� ا��
�، . وا�< ��ت ا�]G� ا�������� ����3 وو�<�6 ذ�� ا� ���ت ا��56� ا���3]| ا� �6: �/ وا���%رة وا��Mاءات ا� �P$� ا��<��� ا��$%آ�،
���� واFM���، و P]%ات ا��% وhY ا��Gا�z و/ ا��2%ق ا����ع وا� .ا���U وا�� ��<�و
19
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Tools for Psychosocial AssessmentTools for Psychosocial AssessmentTools for Psychosocial AssessmentTools for Psychosocial Assessment
• Screening should be routinely established
• Depression in the terminally ill should be
treated as vigorously as for those patients with
a better prognosis
• All staff should have basic skills to determine if there
is any suicidal risk so patients may be managed
Identification of barriers and stressors, which impact
patient and family coping and/or compliance with
treatment must be done in a systematic manner.
So what are some of the tools for psychosocial
assessment? At MD Anderson, we have several ways to
identify barriers and stressors that impact a patient at
family coping or compliance. We may have a patient
who is highly compliant, but there may be a family
member who has a mood disorder or a family member
who is completely stressed out, burnt out and fatigued,
and may not be willing to comply with the treatment plan
or even be supportive of the patient or the medical team.
A lot of our discharges get held up because patient’s
family members do not think that it is the right time for
discharge or are not ready for the patient to be taken
home, because they are afraid of how to care for the
patient. Screening should be routinely established.
Depression in the terminally ill should be treated as
vigorously as for those patients with a better prognosis.
So we are looking at screening at all levels, from the
point of diagnosis to the end of treatment, at the point of
progressive disease and advanced disease. And all staff
must have the basic skills to determine if there is any
suicidal risk so patients may be managed and be able to
refer these patients very quickly to the department of
professionals within the institutions that handle these
issues.
�؟ ���6� و�0/ �� �� ه� �<Z ا.دوات ا��� ���� �� ا� �� ا���56 ا�� �-i3 � �� إم دي أ��ر&%ن �ة #�ق � ���2 ا�<%اOV و��GG�ت ا�jH%ط ا�
$S ا����Z �� ا� <��: �h ا.&�ة أو ا�� �ام ���< ج . SY�� �6��$� ��%ن ��ا، و�0/ ر��� آ�ن ه6�ك أ�F أ��اد ا.&�ة �<��� �/ اY]�اب $� ،�C9� أو �J�[�56 ا� �� ،���w |jY x23 hJا��، أو ��د �� ا.&�ة وا�� Z���$� ة�� S ����3 ا����F ام ��]� ا�< ج أو� و�J � �0%ن را>G� �� ا��
�G[ا� O��5اج. أو ا��Pإ :�i��S5 وآA�ا �� .ن ؛ا���SY �/ ا��� ��ون أن ا�%6� xJ��PM K&ا�[، أو �<�م >� � Z���أ��اد أ&�ة ا� ����# /� �C�%�� ا�l�ا& <�اده� �U]2�ب ا����Z إ�S ا���6ل،
] �� G�رات . رPإ��اء ا K9�23يو� �6رة رو3%W� . �9��>� K9و��ا�?ي �<��z �[ [�5ا�آ R�ب ��ى ا���SY ا�?�/ � ���S ��ؤه� ���2��س
:H�.ذوي ا���ل ا SY��رات ،�?او. ا��G P�6 إ��اء ا>� /2�$S �23ي �C��� ا�< ج، 53 �6��J ا���ض Sإ� _�� ��h ا��� %��ت، �/ ��ا�� ا�
���� � �$F�� �� 0%ن ا���ض� ���6 �� hh أ��اد ا�]��J . و� و�K9 أن � 2�ر���ف ا��%ل ا� �S6 ا� <��: �<C� ��C�رات أ&�&� �� اآ� S F ��
وإF��� ه�iء ا���SY &��<� إ�S ا���� ا�?ي �<�: �[ � �WW%ن �� �$3 ��&i���� ت��ا�2 .
20
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Psychosocial assessment varies by :
• Provider
• Screening tools
• Emotional state of patient at different
point of assessment
• Reporting
Depression ratings were influenced by crying,
depressed mood and medical factors rather than
more reliable indicators such as anhedonia, suicidal
thinking and hopelessness.
So again, psychosocial assessment varies by provider, the
type of screening tools they use, emotional states of
patients at different points of assessment, and the
reporting structure.
� �C� K�F ����3 ا������� ��ة أ�Pى، � 5�وت ا� �� ا���56 ا�� $X أ�%اع أدوات ا� �2ي ا��� ����و�� �� SY��$� ��وا�2��ت ا�%��ا
���ط ا� �� وه0: إ�اد ا� ��ر�� .
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Practical Concerns
• Housing
• Insurance
• Work/school
• Transportation
• Child care
• Caregiver
• Home care
• Prescription coverage
Family Concerns
• Dealing with partner
• Dealing with children
• Spiritual/religious concerns
Emotional Concerns
• Worry
• Fears
• Depression
• Nervousness
• Loss of interest
Physical Concerns
• Pain
• Fatigue
• Sleep
• Getting around
• Bathing/dressing
• Sexual
• Other _____________
NCCN Distress Thermometer NCCN Distress Thermometer NCCN Distress Thermometer NCCN Distress Thermometer
The National Cancer Comprehensive Network of the
United States came up with a very, very valuable
assessment tool for patient distress. This simple tool
looks at four dimensions of patient care. Those
dimensions are the practical concerns, the family
concerns, emotional concerns, and the physical concerns
encompassing the entire patient, which then gives us an
idea for the patient’s distress level on a scale of 1-10.
And, if the patient tells me that he is feeling suicidal, or
he is feeling sad, or he is concerned about his sexual
functioning on a scale of 1-10, his distress level is 6.
Then that tells me something about where I need to start
with this patient and where I need to go with this patient.
$���� �$��#�ن ���%���ت ا�� �2ة أداة J�� ��� x��U ا���0G ا�%#6� ا�SY��ى ا��� OH��� ر%>� �� ا�� ���j$� .و �[�Gول 3$� ا.داة ا��6 3
SY��ا� ���ا��%ا>: وو3$� ا.�<�د ه� ا��%ا>: ا�<�$� . أر�<� أ�<�د ���0: وا.&��� � Z������ |23 � �� ا��Gا>: ا�%�ا��%ا>: ا�%��ا�� وا�
/� � �م، وا� OHى ا�% �� /4�C� أن 3<]6� ��0ة w]6� �� ا�?ي �<� /� z�3ر� S$ Z���1ا� Sوإذا . 10إ� �� �>�� ]�J�ل �� ا����Z إ
2�ر��، أو ��<� ����2ن، أو أ�[ �C�%م ��4ن أداV[ ا���69، ���%ل ا ]��� OHى ا�% وه0?ا . �1-10/ � �اوح ، $S �3ر�z ��60%ن ��
�� ذ�� إ�S ا��%�w�� ]6� ا�?ي ���660 أن أ��أ hY :�>ا� ،Z���ذ�� ا� h�]>� �Hأي ��ى ��0/ أن أ� Sوإ� .
21
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Patients at Increased Risk for Distress Patients at Increased Risk for Distress Patients at Increased Risk for Distress Patients at Increased Risk for Distress
• History of psychiatric disorder/substance abuse
• History of depression/suicide
• Cognitive impairment
• Communication barriers
• Severe comorbid illnesses
• Family/caregiver conflicts
• Inadequate social support
History of psychiatric illness, history of depression,
suicide, cognitive impairment, communication barriers,
severe comorbid illnesses, like diabetes or hypertension
or bipolar disorder or AIDS, all of these will put the
patient at increased risk for distress and more so the
inadequate social support of a patient’s circumstances can
impact the patient’s distress level very highly.
2�ر أو ا�<�9 إن و�%د &%ا� ل ا���56 أو ا�آ R�ب أو ا� � O�Mدراآ� ا OVا%ا����Y ا�����، �A: داء ا� لا� %اU:، أو �� أو
ا���0ي أو ار53�ع ا�jH| أو ا�Y]�اب -6��V ا��]K أو ا��Mز، آ: ذ�� ،k�<و OH��� Z���ا� ���U#� إ�أن ���� �/ �� ]�4w /ن و�m� ا?�
S$ �-i3 0/ أن�� Z���وف ا��l� ���0ا� �< ��� ا������ة ا�� %ى ا�HW� ]��� O%رة آG�ة ��ا�� .
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Patients at Increased Risk for Distress (continued) Patients at Increased Risk for Distress (continued) Patients at Increased Risk for Distress (continued) Patients at Increased Risk for Distress (continued)
• Living alone
• Financial problems
• Limited access to medical care
• Young or dependent children
• Spiritual/religious concerns
• Social problems
Again, patients living alone, how many times and how
often have we had patients being dropped at our doorstep
who have no family, no friends, nobody wants them back
home, or they are so tired taking care of the patient that
they think it is the hospital’s duty to take care of this
patient. Patients with financial problems, limited access
to medical care, they are living in remote locations and
areas and want to be closer to the hospital, they have
young and dependent children, spiritual religious
concerns as well as social problems. And how do we help
these patients? These are the patients at increased risk for
distress, but which are these patients? Who are these
patients and how can you tell?
�� .S ا�?�/ �<�%ن �%�Fه�ا���Yه6��� ��9دا، �Cw آ� ��ة �C� SY���S5، � أ&�ة، � أJ�U�ء، �$�%ن $S أ �ب ا���� �Fأ �C6� K<��
C9ا� �C6� �$� ��ا���6ل، أو ر� Sإ� �C3د�ا����Z ه?ا � �� ر��� �� إ] ���S5 ر ا���SY ا�?�/ �<��%ن �/ . و�6l%ن أن �/ وا�K ا���
��2ود�� ا���رة $S ا�W2%ل $S ا����� ا�]G�، و�/ ا����آ: ا�����، �Cو��� ،S5� ��ل �Jب ا������V� و����ون ا� hJو�%ا O#�6� �� ن%�و�<
وF�، وآ?�� ���آ: وw%ا>: د�6� ر وأ�w�ص �<$%��Cأ#5�ل jU�ر ��� �2% زا�V . ا� S$ �Y����م ا�<%ن ��iCء ا���SY؟ ه�iء Xآ
��]� اUM��� ���HO، و�0/ �/ ه� ه�iء ا���SY؟ �/ ه� ه�iء ا���SY وآX ���60 ا� <�ف $�C؟
22
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Periods of Increased VulnerabilityPeriods of Increased VulnerabilityPeriods of Increased VulnerabilityPeriods of Increased Vulnerability
• Finding a suspicious symptom
• During workup
• Finding out the diagnosis
• Awaiting treatment
• Change in treatment modality
• End of treatment
• Discharge from hospital following treatment
Again, when a patient finds a suspicious symptom after
treatment and feels that, “Oh, gosh, my disease is coming
back, I am not going to through this again and I am not
going back.” Or patients during work-up get into panic
bouts where they feel, “Well you know I am feeling
really sick, my hair is falling off and I think probably this
is not a good sign. I might as well go home instead of
spending so much money on this treatment and save up
all my bucks for my family.” Finding out about the
diagnosis: this is a pivotal moment in the life of any
cancer patient is finding out about the diagnosis. Almost
feels like a death warrant to many. Then awaiting
treatment, anxiety of awaiting treatment, [you know]
“What kind of treatment? How long will this treatment go
on?” “What kind of side effects are going to happen?”
“How can I cope with this?” Change in treatment
modalities, okay, so we finished Herceptin, now we are
going to do Taxol and then we are going to go and do
radiation, or we are going to do surgery. “When is this
treatment ever going to end and what does the end of
treatment mean? “Is that the end of chemotherapy and the
start of radiation or the beginning of immunotherapy?”
“What does treatment itself mean?” “What is the
difference between acute treatment and palliative
treatment?” Discharge from hospital following
treatment? Patients do not understand the differences
between transition -- between transition points, being in
the hospital, being discharged from the hospital, going to
a nursing home or to a hospice.
C� Z���ا� X� 0� ���6%ر أ�اض �A�ة �$�0%ك �<� ا�< ج أآ�ر، <�ا �$��ور "و�6 ��[ ذ�� ا��<%ر �� xو�� ،���� إ��C، ا���ض �<�ود
�%��ت ." �?�� ��ة أ�Pى، و�/ أ%د ��ة أ�Pى �C�� أو ا���SY ا�?�/ 63�ء، وw<�ي "�/ ا�h$C أ-6�ء إ��اءات ا�< ج M�� :>5��� �>wأ ��إ �< �� ��J|، وأ�/ أن �$3 ��G# . ��� � � Sإ� Kو���660 أن أذه
أو�� �?�� �<Z ا.�%ال أن �/ إ�5�ق آ: 3$� ا.�%ال $S ذ�� ا�< ج، و�3�&.." _�� �9 ا�� ���>� : �l2� _�� �9 ا�� ���>� �>3
�ام ����G�6 . �2%ر�� �� F�ة أي ���Z �����#�نM�� �0F ���A�� �C�Z>G$� . �>� ر ا�< ج�l � l�ر ا�< ج، -� ا�� KF�W�ا� O$[ذ��، وا�� �آ� �jق ذ�� ا�< ج؟] "3<$�%ن�& xJ%ع ا�< ج؟ آ� �/ ا�%� ه��� " "��
j3� " آX ���660 ا� <��: �h ذ��؟" "اv-�ر ا�9��G� ا�� %�F hJو-C�؟ /، و&�G6أ اvن �� إ]�ء G&/ ه�� �6C �#�ق ا�< ج، 6�F�، ��� ا
�، أو إ��اء ��ا3�F�آ�%ل، و�<� ذ�� &6�>wMا�< ج ا h� ���J �H� . C�ء ا�< ج؟ "�6 �C ا�< ج و��ذا �<�6 ا& S �C��� �A�� �>���ه: "�
� أو ��ا�� ا�< ج ا��6��؟�>wMوي و��ا�� ا��ا�< ج ا�0" " S6>� �� ���{ا�" �� ا��5ق �/ ا�< ج ا�2�د وا�< ج ا��$]X؟" "ا�< ج ��5[؟ /�S5� �<� ا�< ج؟ � ��رك ا���SY ا��5ق �/ ���ط ا� �6:، ا�%�%د ا���
�S5، ا�?ه�ب إ�S دار Z���3 أو إ�S دار �S5، ا�PMاج �/ ا��� �� ا��� . ر��� �$2��ت ا�� �P4ة
23
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Periods of Increased Vulnerability Periods of Increased Vulnerability Periods of Increased Vulnerability Periods of Increased Vulnerability (continued)(continued)(continued)(continued)
• Stresses of survivorship
• Medical follow-up and surveillance
• Treatment failure
• Recurrence/progression
• Advanced cancer
• End of life
Periods of increased vulnerability, again, could include
stressors of survivorship for patients who survived their
cancer, who have now been treated, their disease is in
remission, but they still need to go back to a normal life.
They still need to pick up the pieces where they left off.
They need to have medical follow-up and surveillance.
They need to understand that, if there is recurrence or
progression, they need to come back, and who do they
need to come back to? Again, how are they going to deal
with advanced cancer issues, end of life issues?
�ات ا�X>H ا��� :��ا�V، ��9دا، ا�<%ا�: ا���F�� �� |jH$� �GG$� و3$J S� ا�2�ة �<� �9�3[ �/ ا���#�ن، ا����Z ا�?ي �3 Z���ء ا����
/� ���F �� ا���ض }GUوأ ،]� hا�� ، و�60[ � ��ال �� F��� إ�S ا��>G[ة ا��ا�2 Sا�<%دة إ� . oF /� ع أ��ه��9� �F �� �C��� إ�S ا&
��<� وإ�wاف #G/ و�2 ��%ن. 5J%3%ا� Sإ� . ]�وه� �� F��� إ��C� S أ �jG6�و 53�J�[، وآ?�� �<��� ا��C9 أ�C ا�<%دة �� F��� �<�ودة ا���ض $
��آ: ا���#�ن � h� :��> ا� � �<%دون إ�C�؟ و��9دا، آ�C60�� X ا� ا�� ����، و���آ: �Jب �C��� ا�<��؟
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Patient Needs Assessment or Patient Needs Assessment or Patient Needs Assessment or Patient Needs Assessment or ePNAePNAePNAePNA
A patient needs assessment screen
to review the various dimensions of
a patient’s care i.e. psychosocial,
nutrition, spirituality, etc.
At MD Anderson, we have what is called a Patient Needs
Assessment, which, a patient-- when the patient comes
into the hospital or as an outpatient, the patient fills out a
self-assessment about their own needs that are on a form,
which are sectioned, or categorized into different
sections. And so, when a patient decides that he is
feeling a stress level from 1 to 10, of 6 or 5 or 4, he will
indicate that on this form. When he does that, that
referral is kicked out to social work to assess for
psychosocial distress. If a patient says that they are not
eating well, they need some nutrition consult, then the
section on nutrition is checked off and the referral is
kicked off to nutrition. If the patient has problems with
mobility and needs physical therapy, or the patient has
problems with bowel management, all of these sections
deal with these problems separately and referrals are
kicked out to the different disciplines to assess the
patients further and meet their needs quickly.
���ت ا������6>� ،Z� ��P: �� � -���6� �� إم دي أ��ر&%ن Fا �� � S�� �� �S5 أو ��34 إ�S ا�<�دة ا���ر��، ��%م ��:ء ��%ذج �$ ا����Z ا����5$ ���3[ ا����U، ���� إ�S أ�J�م أو �X6W إ�S أ�J�م ��F� �3ا�?ا .
%ى �/ ا�jH| ا���56 �و�/ -�، �� /� ���>� ]� �رج mذا �Jر ا����Z أ� /�1 S10إ� A� :6 ذ�� �� ا�6�%ذج4أو 5أو Sإ� ��و��6� ��%م . ، ��
�� ��ى ا�HO ا���56 �3?��، � ��� [ إ�S ا.WP��V ا����Fإ � � ا�?ي ��� �[�� 4�[ � �4آ: ��ا، �K9 أن و. ا��� Z���ح ا��U إذا
$S ا���� ا���ص �� hY%3 ]$��رة >?اV�، و�6�ء �93ى ا& j?�� و�2�����?j3 �V�WPأ Sل إ��آ: �� و. ��� /� ���>� Z���ن ا��إذا آ
��آ: �� ا��2آ�� /� ���>� Z���ن ا��أو آ ،�>G# ج Sج إ�� و�2 6�ول 3$� ا����آ: �W%رة ا� �F �� �02آ� ا.�<�ء، �mن آ: 3$� ا.�J�م &�h� ،�$W56 إF��� ا����Z إ�S ا� �WW�ت ا��� ��M �5$اء ���� �/
� �� $S و�[ ا����ا� ]3��� Fا �G$3و Z���$ .
24
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Strategic Intervention Strategic Intervention Strategic Intervention Strategic Intervention
Psychosocial Need Service
Understanding of illness, treatments,
and services
Strategies to improve patient-provider
communication
Coping with emotions surrounding illness
and treatment
Peer support groups,
counseling/psychotherapy, pharmacological
management of symptoms
Managing illness and health Comprehensive self-management/
self-care programs
Behavioral change to minimize
disease impact
Behavioral/health promotion interventions
such as smoking cessation help, patient
education
Managing disruptions in work, school
and family life
Family and caregiver education, assistance
with activities of daily living (ADLs)
Financial assistance Financial planning, insurance counseling,
eligibility assessment for social security
disability income
So there are different psychosocial needs and different
strategies for each psychosocial need. Whether it is the
understanding of the illness, treatments and services.
And this is not just for patients, but also for the patients
and their families. Coping with emotions, managing
illness, how to manage this illness both at the hospital
and at home. There are a lot of behavioral changes in
patients. Some of them become quite obsessive
sometimes. The families become overanxious
sometimes. And that can have a very dynamic effect on
both sides, including the providers. We do have patients
sometimes who will not listen to any advice or instruction
because they are not emotionally comfortable. And how
do I get this patient there?
�Hك أ���5، وه6$ �� ��� ���ت ��5� ا�Fك ا��5 إه6$ �ا39�ت ��&��� �ج ���5 ا�Fت . �0: ا�ا���ض وا�< � �C5� O$> 3 x�&%اء أآ�
��: أ�H� أ&�ه� [و� �� �W ا.�� $S ا���SY، و�60. وا�����ت� .�<%ا#X وإدارة ا���ض أي آ5� إدارة ا���ض �� آ: �/ ا� <��: �h ا
�S5 وا���6ل . �23ث ا�A0� �/ ا� j�ات ا��$%آ� ��ى ا���SY. ا��� W3�ب ��$O ��5طوا.&� � . �J��&%&%� }GW� Z>G� �� �Z> ا.F�ن
و��0/ أن �i-� ذ�� $S آ ا�]��/ 43-�ا �$j�، ��� �� . �� أF�ن أ�Pى �<%ن $6���� �� . ا�����ت %ذ�� ������ � SY�� ن�F.ا Z>� ��
�<�ون ����ا�F ا�%��ا�� ؛إ�S أ�� �W�2 أو 3<$��ت� � �C�. . Xوآ �� أوU: ا����Z إ�S 3$� ا��ا�F؟ أن
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Patients with Breast Cancer Patients with Breast Cancer Patients with Breast Cancer Patients with Breast Cancer
• Crisis intervention
• Adjustment to diagnosis and treatment
• Coping with life changes
• Stress/anxiety
• Fear, panic, anger, guilt, denial
• Issues related to:– Body image
– Sense of identity
– Sexuality
– Disability
– Grief and loss
– Advance care planning
– Death and dying
So, patients with breast cancer again have the same
problems. We are constantly dealing with crisis
intervention: a patient who is in a panic bout, has major
issues adjusting to the diagnosis, cannot cope with the
idea of maybe a surgery, radiation treatment, the side
effects of fatigue, body image, grief and loss, the fear of
death and dying. And so we try to provide services with
counseling, the transitions of care, and patient protection
or patient safety.
�5� <��: . C�6�F�� ،�����H�ت ���#�ن ا��Aي �<��/ �/ ا����آ: � /2�و�5 �� ��ة �h إ��اء P�3$� �2��ت ا.ز��W�: � Z�����3 ،h$ه ��%� ]�� 6
h� �#�> ��_، و� ��60[ ا� ��آ: آG�ة �� ا� 0h� X ا�� /� ��و�<� ،�Fج أو ا���0ة إ��اء ��ا >Mا ،��>w د، أو�C��� �G�أو اv-�ر ا�9�
و�/ . ا��%ت وأا��%ف �/ ا��%ت، أو ا.&S وا�H�ع، أو U%رة ا���9، �2�ول ����3 ا�����ت / #��O ا� �- ����Fو ����%رة، و�63 ت ا���
Z���أو & �� ا� Z���ا� .
25
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
TRANSITIONS OF CARE
- Assisted living
- Nursing home
- Hospice
- Custodial/provider care
- Home provider
- Extended care facility
- Nursing home
- Assisted living
- Hospice
- Aged and disabled
services
Psychosocial Support Resources Psychosocial Support Resources Psychosocial Support Resources Psychosocial Support Resources
PATIENT PROTECTION
- Guardianship
- Abuse - children and
adults
- Domestic abuse
- Exploitation/neglect
- Clinical ethics
There are different types of counseling and there are
different specialists for the different types of counseling.
And so we must be very aware of who is the right
professional or staff that can do the most effective piece
of counseling for the different issues: adjustment to
diagnosis, crisis intervention, communicating with the
team, making treatment decisions, helping the family and
caregiver to be more supportive, empowering them,
discussing end of life issues. And discussing end of life
issues, there is the point where the physician says, “Okay,
we are at the point where the disease is so advanced,
terminal nature of disease, the prognosis is less than a
few months,” that is discussing end of life in terms of
providing the prognosis. However, there is much more to
that. There is more to discussing the end of life in terms
of, “Okay, so we are at a point here and let us look at
what our goals are from this point onwards. Is this
quality of life? Do we want more treatment? What would
be the impact of that? Where would you like to be at this
point? How would like this to be planned?” The different
mental health resources within the institution and outside.
%� �WW%ن �� $5%ن .�%اع ه6�ك أ� �Hك أ��رة، وه6%�اع �� $�5 �/ ا���5$ $6� أن �0%ن $S و� 3�م �%6� . ا���%رة ا��� K9� ا?�
4�[ أن �%�� ا���%رة w /� ا�?ي �J�[أو ا� K&�6�ا� �U�W Pا� �Aا.آ ���>�:V���ا� X$ ��� : �� �$P� ��_، ا��Mاءات ا� ا� 0h� X ا�
�، ا� %اh� :U ا�O��5، ا�3�ذ ا���ارات ا�< ��، ����ة F��ت ا.ز� ��J�6و� �C ���$S ز��دة ������C3 و��%�3 ���ا.&� و����� ا��
و�����$� �G�6�V: ا�� <$�� �C6��� ا�<��، .ا����V: ا�� <$�� ���ب �C��� ا�<����]� أ� �$F�� ��" :}GU� ��G[$� /0K أن ��Wح Sإ� �6$U، ��� و�6�F
ا�� � ��GC� ا���ض � ���� �$j���، و�� ا���اF: ا�C6�V� �6[، وا���/ hJ% �� ���J ��4ب �C��� ا�<�� �/ "،أH� /� :J<� أ�Cwه% ا��J�6� أي oFhJ% ��_ ا�� �6C�ك أ�%ر . و�0/، -�� أw�ء أآ�A آA�ا �/ ذ��. ا�
C� ��W%ص �C��� ا�<��؛ �J�6� /0�� ى�P6"أ$U، ��� و�6�F Sإ� �k?ه �jG6ا��6]� و����� �23�C� �/ اvن $ � 6� ا� 05� �� ا.ه�اف ا�
�ا�W� . ة؟�ا�2 �%� �� �05 2 �ج إ�S ���� �/ ا�< ج؟ و�A: ا��ه: آX وأ�/ H53: أن 03%ن �6 3$� ا��6]�؟ ووآX &0%ن 43-� ذ��؟ � داP: ا��i&�� ا��%ارد ا��� �2W$� �5$ ا�K<�3 "�56 �� ا� �]| �?��؟
�Cر��Pو.
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Psychosocial Support Resources Psychosocial Support Resources Psychosocial Support Resources Psychosocial Support Resources
FINANCIAL ASSISTANCE
-Insurance
-Employment issues
-Health insurance
-Governmental/state assistance
-Short/long term disability
-Cancer help organizations
DOCUMENTS
-Visa letters
-Letters to attorneys, criminal
justice system, patients and
family members to employers
or schools, FMLA, military
leave, jury duty excuse
TRANSPORTATION
-Volunteer airlines: Angel Flight Corporate Air Angel,
Air Lifeline Mercy Flight,
Freedom Flight
-Air Ambulance
-Gas, bus, cab vouchers
-Parking
-American Red Cross
-American Cancer Society
HOUSING
-Contracted programs
-Hotels, motels
-Guest programs
-Charity organizations
PHARMACY/SUPPLIES
-Explore resources/indigent
drug reimbursement
-Provide information
EDUCATION/INFORMATION/
REFERRAL
Now, there are also other concrete resources, which are
equally important and that address the practical concerns
of a patient’s day-to-day treatment journey, and that is:
housing, transportation, financial assistance, pharmacy,
education, documents. These are not small issues.
� �3: �� ا.ه��، و3 6�ول ا��%ا>: ا�<�$� ه6�ك �%ارد أ�Pى �$�%&�:A� ،Z���$� ��%ا�< ج ا� �$F�� :/0�6: و ا�� ا�����ة ا�����وا�
�و ا.دو��و% .3$� ا.�%ر ���jU :V�ةو� 3< �G . ا��� �6اتو ا�
26
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
• Social Work
• Place…of Wellness
• Psychiatry
• Chaplaincy
• Anderson Network
• Fatigue Clinic
• Neuropsychology
• Cancer Prevention
• Patient Advocacy
• The Learning Center
• Supportive Care
• Palliative Care &
Rehabilitation Services
• Pain Management
• Ethics Services
• Tobacco Treatment
• Sleep Clinic
Psychosocial Support Services at MD AndersonPsychosocial Support Services at MD AndersonPsychosocial Support Services at MD AndersonPsychosocial Support Services at MD Anderson
A patient came in for cancer treatment, was told what the
estimated bill would be, this patient was self-pay. Patient
paid up a certain amount as a deposit and then was told
that he can go in for a couple of consults. The patient
went for consults, went and checked on his bill. The
amount that he had deposited was almost now down to
half. The patient was shocked and the reason being that
the patient had not been adequately informed or provided
the information about what happens at each stage. The
patient said, “Hey, I have been here only for two consults
and one test or two tests and the bill is so much.” Well,
all the rates were then provided to the patient and he
finally understood where his money had gone, and how
quickly the money can go, and what we need to do to
make sure that he is still able to continue his treatment.
So, now at MD Anderson Cancer Center we have several
departments that help with psychosocial support services
and each area has its area of expert professionals who
work with patients to resolve psychosocial concerns and
issues.
�Jن، و�ج �$��# ��$ � Z���3%رة ا����رة، اأ�3 ا��ا�5 ��J S$ h$# oFص�[ ا����0$�5 �/ � د�h ا����j$G� Z� . آ�ن ذ�� ا����Z ���د ا�
��رات ����،�<6� آ��<� � أ��ى . وأ�GP �4ن $[ إ��اء �د �/ ا�&Z���3%ر3[ ا��25_ �� Kف وذه�W���رات، وا ��� ا��xH5 . ا�&
XW6ا� S5<: إ���� �C�Uم ا����Z، وا��KG أ�[ �� �]$h . ا���<� ا� � أود�$F�� :�2ث �� آ� �4ن ��J�ل . ��6� :0�K& أو �� ��ود ����<$%��ت �
Z���ا�" : �� ،�l2� ،/6-أو ا �Fر وا�G P/ وار3�� أ�� ه6� &%ى ا&�C� ���G� 3%رة�و". وا�5�- /� ���C� �� �C5� ،ر�ا.&< h�� Z���$� x��J
Swا.�� أ�/ ذهxG أ�%ا�[، وآX ��0/ �~�%ال أن 3 �، و�� ا�?ي ��� 4آ� �/ ا& ��ار �Jر3[ $S �%اU$� ا�< ج$� ]$>� �6� �jG6� .� �� �6��� ،ا?
�� �آ� إم دي أ��ر&%ن �$��#�ن �ة أ�J�م �$����ة �� ��P ����3�ت ا�� h� ن ا�?�/ �<�$%ن%WW� �، وآ: �9�ل �[ �GPاؤk ا���� ا��56� ا��
��� $F S: ا��%ا>: وا����آ: ا��56� ا�� SY��ا� .
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
• Individual and group counseling: Screen and identify high risk
patients and families, crisis intervention, adjustment to diagnosis
and treatment
• Transitions of care: Pre-hospice, nursing home, assisted living
assessment, education and counseling
• Protection issues: Guardianship, abuse (child and adult), domestic
violence, exploitation/neglect
• Resources for housing, transportation and practical quality
of life concerns
• Custodial/provider services information, mental health resources,
family service centers, etc.
• Advance care planning
Department of Social WorkDepartment of Social WorkDepartment of Social WorkDepartment of Social Work
Psychosocial Counseling Services
The Department of Social Work provides individual and group counseling that identify and counsel high-risk patients and families, provide crisis intervention, and help with adjustment to diagnosis and treatment. They help with transitions of care. So if a patient is going into hospice, just to tell the patient, “Oh you know I am going to get you connected to hospice,” means nothing. But to be able to explain to the patient what hospice can do, how will it help the patient in the long run, what does it actually mean, and making the patient feel completely comfortable about this new transition to care, because, if you do not do that, the patient is going to come right back through our emergency center and not have the quality of life that they could have got otherwise. Protection issues like guardianship,
S3� رات -�د+ و����, ��5�3ف�H�Lت ا������, ا�' I2 ا��J م V+ 2+ V%رة �24، و*H2 ا��+ V%ا���5, و ���I�3� 6,Y�5ا�� �L�وا SYا���
�ز' ، وا����� ة �S3 ا��?,` 'N ا��IH,. إ��اءات % <��k �- ,3ت ا-Tذا آ�ن ا���+l . آ�� +��� -� ا���p> 6,O &V*ات ����3+ . وا�h5ج
j� ل*V% ن� S�5' h- ،ة�>qدار ر��+ �3!��ت ا��� Sإ� &V�,L" S3� o/أ S3� &��qL �� ار ر��+ �3!��ت EO وS3� G5Y ا%=�ل�23 أ/
�+l '� ا�eي +�?6 � ور ر��+ �Hح ��3%و�?U$+ 6 أن ". ا���q<�ة�4 '��� ة ا���+S3� l ا�� ى � +�j، وآ,` +�?V% ة�>qا�!��ت ا��� de4� '�% kا�O �5H+ l+و�5& ا��� ، V,V!ا� �- ��ا�p*+&، و'�ذا 5%
ة -� ا����+ + ��د ؛ا��3V ا�$J l+ا��� $��- ،G�eO 2V% 2� إن G/��*�, ا�!,�ة ا��� آ�ن +�?6 ، و�S3� �+ 6 ا��*ر إ�S '�آ7 ا�p*ارئO N��
�4O Sr!+ ا. أن +�b*ا� &�' +��!��O V35ا��� &Bءة ا���5'3 و�����Lإ+�5/� ا�?�,� 'SY�' 6 ا�����ن '6 . ا�5�` ا�����7 وا�hi�Lلو
+3�5*ن �S3 ا�hi�Lل أو إ�Lءة ا���5'3 ، و� +5�� ذ�G و�*د أ{�Iص l+ءة '�5'3 ا����H)5& -� ا�����O ،7ل� &O3V�' +ا���� �' V' ن�ن *
Jء و(�ر�E���O*2ه kو `J*ا�� N' &'�524 ا���'*ارد . ن -,�4 و� +�?
27
abuse, domestic violence, exploitation. A lot of cancer patients do have issues with being exploited or abused, not because there are actually abusers in the home, but because the caregivers are completely burdened and overwhelmed and are not able to cope with the situation themselves. Resources for housing, transportation and practical quality of life concerns, custodial and provider services information. This is very, very important because patients, -- this is the first time they have been hit with something like this. They have no idea of where to start, where to go and what to do. And advanced care planning in terms of, “Okay, so this might take another six months to a year, or two years or five years. Let’s look at what we want to do; what are the different things that could happen and how do we want to proceed in a planned manner?”
�*�, ا�!,�ة، و'35*'�ت O V35ا(& ا�3�5, ا���*Hت، وا���V�/ا��?6، وا� '�تIا� �' V'و ، ,B�b*ت ا��' I6 ا�� . �,k ، +�i3� 24' �'�ا اeه j/أ
\E�+ 2� 3� SY3 ا���ور�����' O�$�O &EJ 6' . ة�?- S/ه2 أد �و�,� � ؤون'6 أ+6 E+35*ن� م ����3+ . ، وإ�S أ+e+ 6هE*ن، و'�ذا +Vا�� _,pIوا��
&�' *!/ S3�" أ{�4 أ<�ى، أو ��'�، أو �L �'�ق ا�i��+ J ،���k�� ��j3. ��',6، أو <�� �3� ا��� ه� ا�'*ر '� : ��� '� ا�eي +�?�Iا��
��r ؟+�?6 أن ' V+�pO �4��,k وآ,` +�?6 ا��=�ف ،NV% "
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
PlacePlacePlacePlace...of Wellness...of Wellness...of Wellness...of Wellness
• Integrative medicine consultation
• Acupuncture
• Massage
• Individual and group counseling
• Support groups
• Expressive therapies (art, music)
• Movement therapies (yoga, tai chi, pilates)
• Nutrition groups and consultation
• Relaxation techniques
• Complementary
We have The Place of Wellness that helps patients with integrative medicine consultation. They have acupuncture. They have massage. They have individual and group counseling, support groups, expressive therapies like art and music. There is yoga, tai chi, nutrition groups, relaxation exercises and complementary medicine consults that give patients another alternative to the cancer treatments, or complements the cancer treatments that they are undergoing currently.
��+ ا�eي +��� ا���h> 6' SYل ا�H�Lرات �E, " ا��5-, '�آ7 "� م ا�H�Lرات -�د+ . ا�� �,Gو. -� jO ا�*<�Os�O 7او+�*. %?�'3, V+ *وه
SV,L*ن وا��*��آ�� . و����, و'$�*��ت د�2 و���hت E5%,�+ '�& ا� م ا�,*(� وV+ا��H% رات ��ي�H�Lء وا�>��Lو%��ر+6 ا +ei% و'$�*��ت ،
اB& أ<�ى ���h5ت ا�����ن، أو '?�3 ��4، O SYا��� ���% ,3,�?% ,E��,��k +ا���ر &Bا E6 ا�,O 6' .
28
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
PsychiatryPsychiatryPsychiatryPsychiatry
• Counseling for individuals, caregivers, couples
and children
• Medication management for psychiatric disorders
• Treatment for sexual dysfunction and substance
dependence
• Physician referral required
Also Psychiatry helps with medication management for psychiatric disorders while providing counseling for individuals, caregivers, couples and children. They also help with the treatment of sexual dysfunction and substance dependence.
,����r,2 أدو+ ا��pYا�Oت ا�% �- ����آ�� +��� أ+^� 2�J ا�Up ا� +2 ا��H*رة ��-�ادV% U/�� Sل إ��� '� ا����+ وا�زواج وا��V'آ�� . و
أ+^� -� �hج <3& ا�داء ا�$��� وإد'�ن ا��*اد���+ .
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
• Spiritual support to all patients, family members and staff
• Spiritual support for all faith traditions
• Visits from a particular religion upon request
ChaplaincyChaplaincyChaplaincyChaplaincy
Chaplaincy is a wonderful department at MD Anderson that helps with spiritual support to all our patients and family members. And this support is provided for people from all faith traditions.
�,k ن*Lر ا���Jم ا����,7ة -� إم دي أ/kأ ,�� '�ت ا�?I2 ا��J و+5 +2 ا� �2 ا��وSY��3� �k وأ�Lه2V% S3� ���+ .
29
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Anderson NetworkAnderson NetworkAnderson NetworkAnderson Network
• Connects patients with patients
• Two hospitality centers
• Patient/caregiver telephone line
• Pediatric caregiver telephone support network
• Annual patient/caregiver conference
• Weekly educational presentations (PIKNIC)
• Adult patient camp and day trips (camp carefree and day away)
• Community outreach programs
• Online support: Cancer Survivor Message Board, WarmNet, Ask the Expert
We have what is called The Anderson Network that is a network of patients who have been diagnosed with cancer, treated with cancer, and are part of the MD Anderson family. So this Anderson Network connects one patient to the other. A patient with breast cancer with metastatic disease, Stage 1, might be connected to another patient who has a similar diagnosis, disease has been treated or undergoing treatment, and help the other patient to find some support with emotional, psychological, and cultural issues. There are hospitality centers all around the hospital. There are patient/caregiver telephone lines. They have adult patient camps, community outreach groups and online support groups through The Anderson Network.
�� '� +E} j,3� \3p? أ/ رL*ن، وه� {E? '6 ا���SY ا�eي + و��O O�bs�O ا*=I} ة إم دي و%�5-*ا �����ن�Lا �7ءا '6 أ*!Ebوأ j�'
{E? أ/ رL*ن �S3 رO_ ا���5O SY^24 %�5& ،و'6 �2. أ/ رL*نl5EO . Sو��3 اk�3 -� ا���,V�����O ^+��� 6?�+ �,kن ا�� ي ا�
��/ .,IH���O أ<�ى ^+��O ا�%=�لj وا���ض j�' o-�5%أو و � ,J ة ا���+^ ا %7ال �<�ى -� ا��5*ر �l5O S3 ا� �2 ا�h5ج، �����
,-�Vوا�� ,���و%*� '�اآY 7,�- . وا����/ ة -� ا�'*ر ا�*� ا/, وا�S�Hأ/!�ء ا���� N,�� �- .و%SY��3� ,� '� ا����+ /*� <p*ط ه�%V' .
'I,��ت �SY��3 ا�i��E,6 و'$�*��ت %*�, '$��5, %آ�� �* . رL*نو'$�*� �3 �2 ا��h> 6' �}�Eل {E? أ/
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
CancerCancerCancerCancer----related Fatigue Clinicrelated Fatigue Clinicrelated Fatigue Clinicrelated Fatigue Clinic
• Comprehensive evaluation of fatigue
• Patients with or without evidence of cancer
• Physician referral required
We also have a Cancer-related Fatigue Clinic. And we know, we all know that fatigue impacts the quality of life of a patient just like pain, and can, in fact, drive a patient into serious depression. Comprehensive evaluation of fatigue, and again, for patients with or without evidence of cancer, this can be done at our Fatigue Center.
�� �,�دة �h5ج ا�4�sد ا���%������O _Eنأآ�� + �!6 /235، وآ3�� . ن �-�� �k ,�*/ S3,�ة ا���+j3�' l '�& ا��2، وZ+ �4د�s235، أن ا+ �- j�?�+
+ و+�?6 إ��اء %V,,2 . ا�*اNJ أن +Zدي l+����O إ�S ا� <*ل -� اآ��vب { O�bsا S3� &B24 د�+ {�'& ����4د، �L SY��3*اء '6 و� ت �
�� و������Oن أ+ 2 %*� ، -� '�آ7 ا�4�sد �� .
30
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and CopingChild, Adolescent, and Young AdultChild, Adolescent, and Young AdultChild, Adolescent, and Young AdultChild, Adolescent, and Young AdultPsychosocial Outreach ProgramPsychosocial Outreach ProgramPsychosocial Outreach ProgramPsychosocial Outreach Program
• Child and adolescent life
• Pediatric psychology and
neuropsychology
• Pediatric education
• Career and vocational counseling
• Kim’s Place
We also have a Child, Adolescent, and Young Adult Psychosocial Outreach Program for children, adolescents, siblings, parents of children. We have a wonderful place called Kim’s Place where children can go and play games and connect with each other.
��� ,����� أ+^� g'�/�O ��3*�, ا�+ � �EH3ب ���3اهV,6 و���ل وو+*���ل و��� j%�' م <V+6 و�,V��3اه�ل وأه24,3���� . {�Vء ا��+ � آ�� +*�
S� + NB�5ب '!& '?�ن را��ا Lر���� dل ار%,�د����� 6?�+ �,k 2,آ^5O 24^5O N' &b�وا��*ا .
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Patient AdvocacyPatient AdvocacyPatient AdvocacyPatient Advocacy
• Complaints
• Unresolved issues
• Questions about MD Anderson
• Resources and services
Patient Advocacy helps with patient complaints regarding, maybe wait times. Maybe they do not like the way someone has spoken to them, or they are not happy with the billing concerns or issues. Patient advocacy will assist patients and navigate them through the right channels to address their questions and concerns.
م 2�J ا� -�ع �Vk 6*ق ا���SY ا����� ة �SY��3 -� {?�واه2، V+وh�' ،ر�r�/7'6 ا�O \35�+ ��,- . �4O ث أو �/24E$5% 2� j ا�V+�p ا��� %!
ه2 إ�,24، أو �/24 (,� راUE�O 6,Y و�*د {*ا(& أو '�Hآ& kأ<�ى أ�*ا%,���O \35�% .- م 2�J ا�V+و SY��3� ة �ع �Vk 6*ق ا���SY ا�����
���رات أو ا�H*ا(& ا��� �Lات ا�=!,! ����5$ ا�*�Vا� Sو+*�244 إ� J +24 %?*ن� .
31
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Learning CenterLearning CenterLearning CenterLearning Center
Latest information on:
• Cancer care
• Support
• Prevention
• General health and wellness
We have a wonderful Learning Center that has immense information and updated information on cancer care with every type of cancer, the support, prevention programs, and general health and wellness information.
� �6 ر��+ �� '�آ7 %235 راNB +!�*ي �S3 '35*'�ت ه�3B و'!+ � �*+'�SY ا�����ن �?& /*ع '6 أ/*اع ا�����ن، و'35*'�ت �6 ا����/ ة،
. ��5' وا��-�ه و�Oا'g ا�*�J+ وا�=! ا
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Supportive Care CenterSupportive Care CenterSupportive Care CenterSupportive Care Center
Assessing and managing cancer related:
• Physical and emotional symptoms
• Preventing or minimizing losses of
physical functioning
Our Supportive Care Center assesses and manages physical and emotional symptoms, preventing, minimizing losses of physical functioning, and this is very, very crucial to our patients who have mobility issues.
/, وا�*� ا/, و+��5'& '�45، Eاض ا����ة ا و+V,2 '�آ7 ا����+ ا����/ ان -� ا�*B�f` ا�$���/, ، وه* أ'� '24 +! '6وو+!*ل دون V- وث k
h?H' 6' ي +�5/*نeا� �/�Y��� E����O +�i3ا�!�آ ت� �- .
32
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Pain ManagementPain ManagementPain ManagementPain Management
• Comprehensive pain assessment
• Multidisciplinary pain treatment for inpatients
and outpatients
• Treatment for acute and chronic pain related
to cancer
Pain Management, again, we have a superb Pain Management Service that does comprehensive pain assessment and treats acute and chronic pain related to cancer.
��+ ' را5B ����5$ ا��2 %$�ي %V,,�� ، '�ة أ<�ى، '��5$ ا��2، �>pE%ا��� � . ������Oن{�'h ���2 وg��5% ا��م ا�!�دة وا��7'
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Ethics Consultation ServiceEthics Consultation ServiceEthics Consultation ServiceEthics Consultation Service
• Patients and caregivers who face difficult decisions
related to medical treatment or other aspects of care
• Ethics consultation advisory only
• Available 24 hours/7 days a week
• Strictly confidential
• Free of charge
Our Ethics Consult Service is available 24 hours, 7 days a week. This is strictly confidential. And patients and caregivers who face difficult decisions related to medical treatment have the privilege of asking for an ethics consult with their providers to be able to make a reasonable decision.
ى او%�*' S3� ��+ � ,Jh>�رات ا�H�Lا� ' ��L �*ال 24-� < '� ا����+ ا�SY��3� 6?�+ �,k� 6+e و. وه� i��O ا���+ . ا�EL*عV�
pج ا�h5��O \35�% E5b ارات�J رة +*ا�4*ن�H�Lا U3� 7ة,�O Nا���� �E '�ت ���3?6 '6 ا%�Iذ �Jار Iا� �' V' N' ,Jh>لأ*V5' .
33
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Neuropsychology and Chemo Brain Neuropsychology and Chemo Brain Neuropsychology and Chemo Brain Neuropsychology and Chemo Brain
Neuropsychologists provide:
• Assessment of cognitive and neurobehavioral
symptoms
• Intervention strategies for cognitive and
neurobehavioral changes due to cancer, cancer
therapy or co-existing problems (MIND Clinic)
We have Neuropsychology and ChemoBrain Clinics that help with assessment of cognitive and neurobehavioral symptoms, which come up with intervention strategies for these patients with chemobrain.
����3 ة آ�� %� �B�,�,?غ ا��' �� �,�دات /��, �=E, و�,�دات ا�+ � �* N' �4r% ا��3*آ, ا��� ,E=5(�اض ا���5-, وا��2 ا,,V% �-
' 'N ا���SY ا�eي +�5/*ن '6 إI3, ا����> ��Lا%,$,�ت ا��sاءات ا�� . ا�?,�,��B ا� '�غ
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Cancer Prevention Cancer Prevention Cancer Prevention Cancer Prevention
• Comprehensive and site-specific
cancer screening
• Risk assessment and risk reduction
• Smoking cessation and programs
• Genetic testing
Also our Cancer Prevention Center that does cancer
screening, risk assessment, has smoking cessation
programs and genetic testing.
G�رات يو��9Pن ا�ا���# /� ���J%�2ي��آ� ا� ��$��#�ن و�3� � G�رات ا�و [ ��ا�J�� z ع / ا� �P/�$���#�، و���Pا��را-% .
34
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Tobacco Treatment Tobacco Treatment Tobacco Treatment Tobacco Treatment
• Voluntary program
• Counseling and tobacco-treatment medication to
eligible MD Anderson patients
• In-person behavioral counseling
• Over-the-counter nicotine replacement
• Therapies
• Tobacco-treatment prescription medication
Our tobacco treatment is an extremely effective program
that helps with patients who want to stop smoking. And
this again, they provide behavioral counseling on an
individual basis and also provide over-the-counter
nicotine replacement therapy.
�ة ا�����9� ذ �P/و�<� �����69� �$< ج �/ ا���� �� �j��� ءة�آ5Mن �� ا%G<�� /�?ا� SY��عا� J /P� ��رات . / ا� و���م أ�H� ا&
/ ��Wف �j� آ�� ���م �� ��� �$60%3 .&$%آ� $S أ&�س ��دي�G# �5Uو.
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
Sleep Clinic Sleep Clinic Sleep Clinic Sleep Clinic
For patients with the following symptoms:
• Sleep apnea and snoring
• Restless leg syndrome
• Insomnia or excessive daytime sleepiness
• Behavioral sleep disorder
We have a wonderful Sleep Clinic that helps with the
sleep apnea, restless leg syndrome, insomnia and
behavioral sleep disorders; a lot of counseling, and
management of their sleep cycles.
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35
Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast Psychosocial Impact of Breast
Cancer Cancer Cancer Cancer ---- Hoping and CopingHoping and CopingHoping and CopingHoping and Coping
• Assess and manage chronic cancer-related symptoms
• Help patients attain the best possible quality of life
• Physician referral required
Palliative Palliative Palliative Palliative CareCareCareCare and Rehabilitation and Rehabilitation and Rehabilitation and Rehabilitation
Our Palliative Care and Rehabilitation Center assesses
and manages chronic cancer-related symptoms. This
could be while they are undergoing active cancer
treatment, or when they come to the end of their
treatment, when they are at the end stages of their
treatment or in the advanced stages of their disease. This
service helps patients obtain the best possible quality of
life by coordinating their symptom management between
pain and fatigue, emotional, psychological, physical and
spiritual. Again, physician referral is required and this
service also helps patients understand the difference
between symptom management in acute care treatment,
and symptom management at the end of treatment where
it is mainly palliative and end of life therapy. So, we
come to the end of this presentation with the psychosocial
support for patients with breast cancer and I do hope that
this presentation was useful to you. Thank you for your
time and attention.
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